Abstract
PURPOSE: Readmissions to a different hospital may place patients at increased risk for poor outcomes and may increase their overall costs of care. We evaluated whether mortality and costs differ for patients with colon cancer on the basis of whether patients are readmitted to the index hospital or to a different hospital within 30 days of discharge. METHODS: We conducted a retrospective analysis using SEER-Medicare linked claims data for patients with stage I to III colon cancer diagnosed between 2000 and2009 who were readmitted within 30 days (N = 3,399). Our primary outcome was all-cause mortality, which was modeled by using Cox proportional hazards. Secondary outcomes included colon cancer-specific mortality, 90-day mortality, and costs of care. We used subhazard ratios for colon cancer- specific mortality and generalized linear models for costs. For each model, we used a propensity score-weighted doubly robust approach to adjust for patient, physician, and hospital characteristics. RESULTS: Approximately 23% (n = 769) of readmitted patients were readmitted to a different hospital than where they were initially discharged. After adjustment, there was no difference in all-cause mortality, colon cancer-specific mortality, or cost of care for patients readmitted to a different hospital. Patient readmitted to a different hospital did have a higher risk of short-term mortality (90-day all-cause mortality; adjusted hazard ratio, 1.18; 95% CI, 1.02 to 1.38). CONCLUSION: Readmission to a different hospital after colon cancer surgery is associated with short-term mortality but not with long-term mortality nor with post-discharge costs of care. Additional investigation is needed to determine how to improve short-term mortality among patients readmitted to different hospitals.