Early Readmission to Hospital in Cancer Patients with Malignant Pleural Effusions: Analysis of the Nationwide Readmissions Database

ABSTRACT Background Hospital readmissions are costly to healthcare systems and represent a measure of quality care. Cancer patients with malignant pleural effusions (MPE) are at high risk for rehospitalization, yet risk factors for readmissions in this population are not well described. Understanding the incidence and risk factors for readmission could facilitate the development of a readmission reduction strategy in this patient population. Methods We conducted a retrospective cohort study using the Nationwide Readmissions Database (NRD) (2014 sample) to determine the proportion of all-cause, unplanned, 30-day readmissions to hospital among patients with MPE. Survey weighting methods that accounted for the NRD sampling design were used to generate nationally representative estimates. We used multivariable logistic regression to determine predictors of early readmission. Results There were 27,900 unplanned readmissions after 108,824 index hospitalizations for MPE, a rate of 25.6% (95% CI, 25.0% - 26.3%). The mortality rate during readmission to hospital was 17.3% (n = 4840; 95% CI, 16.6% - 18.1%)). Mean cost per readmission was $15,452 USD (SD ± $415) with total aggregate costs of greater than $400 million USD. Predictors of early readmission included having Medicaid insurance status, treatment with thoracentesis only, and discharge to a care-facility or home healthcare. Conclusions One in 4 patients with cancer and MPE are readmitted to hospital within 30-days of discharge, and nearly one in five died during the readmission. Non-definitive management with thoracentesis led to more readmissions. A further understanding of factors that drive preventable readmissions could significantly improve quality of care in this population.