The Length of Stay and Readmissions in Mastectomy Patients

Open Access
Author:
Sun, Susie Xinying
Graduate Program:
Public Health Sciences
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
March 17, 2015
Committee Members:
  • Christopher Hollenbeak, Thesis Advisor
  • Anna Leung, Thesis Advisor
Keywords:
  • mastectomy
  • readmissions
  • length of stay
  • breast cancer
  • breast surgery
Abstract:
Background: Interest is growing in preventing readmissions as payers start to link reimbursement to readmission rates. The purpose of this study was to assess factors that contribute to 30-day readmission rates for women undergoing mastectomy for breast cancer. Methods: Data from the Pennsylvania Health Care Cost Containment Council was queried for women undergoing mastectomy for breast cancer during 2011 (n=2,919). The outcomes measured were length of stay (LOS) and 30-day readmission. Univariate comparisons between characteristics of readmitted (n=172) and non-readmitted patients were performed using t tests and chi-square tests. Readmission was modeled using logistic regression; LOS was modeled using linear regression and controlled for potential confounders. Results: In multivariate analyses, patients with peripheral vascular disease were more likely to be readmitted (OR 4.36, p=0.002). Increased LOS was also associated with increased odds of readmission (OR 1.26, p=<0.0001). Since LOS was an important predictor of readmission we also estimated determinants of LOS using linear regression. The occurrence of reconstructive surgery (p=<0.0001) and renal disease (p<0.0001) were highly predictive of longer LOS. Conclusions: This study showed peripheral vascular disease and longer lengths of stay were associated with higher odds of readmission in women undergoing mastectomy. Clinicians should be cognizant that optimizing a patient’s vascular status before mastectomy may lead to lower rates of readmission. Additional research is needed to determine whether the relationship between readmissions and length of hospital stay is a causative versus associative phenomenon since length of stay is a modifiable factor that may lead to lower readmissions.