The impact of readmission hospital on failure-to-rescue rates following major urologic cancer surgery.

PURPOSE: Patients readmitted to secondary hospitals rather than the primary hospital where their surgery took place may be at risk for poorer outcomes. We sought to evaluate the effect of site of readmission on failure-to-rescue complication rates following urologic cancer surgery.

MATERIALS AND METHODS: Retrospective review of major urologic cancer surgeries in the Washington State Comprehensive Hospital Abstract Reporting System between 1998 and 2013. Failure-to-rescue (FTR) rates, defined as inpatient death after a complication requiring hospital readmission, were compared between patients readmitted to their primary hospital with those readmitted to a secondary hospital. Multivariable logistic regression (MVA) models evaluated the association between readmission site and FTR.

RESULTS: Of 31,498 eligible patients, 3,113 patients were readmitted to hospital within 90 days of surgery, of whom 29.2% were readmitted to a secondary hospital. The highest FTR rates were following cardiac (11.6%), respiratory (11.2%), and sepsis-related complications (10.0%). When limiting to patients who underwent surgery in a high-volume center, the odds of FTR were 4-fold higher when complications were managed in a secondary hospital (OR = 4.06, 95% CI: 1.67-9.89).

CONCLUSIONS: The institution where patients present for postoperative complications is associated with differential mortality outcomes. Upon validation in a large cohort, these findings may inform quality improvement initiatives that target postoperative readmissions, algorithm-based approaches to post-surgical management of complications, and guide clinical decision-making around hospital transfers.