Factors affecting hospital readmission rates for breast cancer patients in Western Australia

Abstract

BACKGROUND AND OBJECTIVES: Unplanned hospital readmissions following surgical treatment for breast cancer are an indicator of morbidity. We explore the relationship between the risk of unplanned hospital readmissions and various factors, including tumor size and histology, lymph node involvement, the type of surgical treatment, mastectomy or breast-conserving surgery (BCS), and patient demographics. METHODS: Linked Western Australian cancer mortality and hospital morbidity data were used in the assessment of readmissions following initial surgical treatment for breast cancer. Planned admissions for adjuvant treatment such as chemotherapy or radiotherapy were deleted. Survival models for multiple events per subject were applied to analyze the data. RESULTS: Hazard of unplanned readmission rises by a factor of 1.005 for each mm in tumor size, is reduced by about 40% for metropolitan residents over rural-based patients, and by 4% for patients whose initial surgical treatment was BCS over mastectomy patients. Area of residence interacts with other factors, including patient age, lymph node involvement, and tumor histology. CONCLUSIONS: While use of BCS appears associated with lower long-term rates of unplanned hospital readmissions than those following mastectomy, the roles of other factors remain important. Patients living in metropolitan areas have significantly lower rates of readmission than rural/remote counterparts. J. Surg. Oncol. (c) 2007 Wiley-Liss, Inc.