Fragmentation of care is associated with an increased risk for adverse outcomes, but data are limited on this topic in the gynecologic oncology sphere. A study presented at the Society of Gynecologic Oncology 50th Annual Meeting evaluated risk factors and outcomes associated with fragmentation in surgically treated ovarian cancer patients.
Researchers used the National Readmission Database to gather data on all-cause 30- and 90-day postoperative readmissions in operative ovarian cancer patients between 2010 and 2014. The study authors defined fragmentation of care as “readmission to a hospital other than that of the index hospital of primary surgery.” They compared differences in readmission length of stay (LOS), charges, and mortality rates between patients based on fragmentation status.
Among 10,445 30-day and 16,656 90-day readmissions in operative ovarian cancer patients, the rates of postoperative care fragmentation were 20.8% and 25.4%, respectively. Fragmented readmissions were associated with higher mortality rates in both 30-day (4.7% vs 3.1%, P < 0.01) and 90-day (4.3% vs 2.8%, P < 0.01) readmissions. There were no significant between-group differences regarding readmission LOS and charges.
The following risk factors were independently associated with fragmentation of care: Medicare insurance, lower income quartiles, and discharge to a nursing facility; in contrast, factors correlated with decreased fragmentation risk included operation at a metropolitan teaching hospital, presence of extended procedures, lymphadenectomy, and 22 postoperative blood transfusion.
The study authors concluded their abstract by stating that one in five postoperative readmissions among operative ovarian cancer patients experience fragmented care tied to higher rates and risk of mortality; they also recommended optimizing short- and long-term postoperative follow-up to reduce fragmentation of care risk and rates in this population.
- Cham, T. Wen, A. Friedman, J.D. Wright. Fragmentation of postoperative care after surgical management of ovarian cancer at 30 days and 90 days