Reducing OB/GYN Readmissions

Rachel M. Sisodia, MD, a gynecologic oncologist with the Massachusetts General Hospital Department of Obstetrics & Gynecology and the Mass General Cancer Center, discusses a Mass General study investigating how to reduce readmissions in patients undergoing treatment for ovarian cancer.

In 2009, the federal government calculated that the United States spends more than $2.2 trillion each year on health care, which is 16% of our national budget. That same year, a sentinel study was published in the New England Journal of Medicine showing that approximately one in five Medicare patients will have an unplanned readmission to the hospital within 30 days of their discharge to home. The combined cost of these readmissions was more than $17 billion.

Readmissions may be expensive, but they are also costly in other regards. For oncology patients in particular, readmission can delay chemotherapy or radiation treatments, create exposure to hospital acquired infections, increase stress on a patient and their caregivers, and reduce the patient’s ability to spend time with family and friends. Most of the data surrounding readmissions are complex, making readmissions difficult to predict and often unpreventable.

In 2013, the Division of Gynecologic Oncology at Mass General investigated our own readmission rates. The primary goal of the study was to identify patterns which predict the patients that will be readmitted; the ultimate goal was to figure out a way to prevent these readmissions from happening. In order to do this, we looked first at our highest-risk patients: women undergoing debulking surgery for ovarian cancer. These are extensive surgeries, often requiring the removal of multiple organs.

In our study, we reviewed all patients undergoing surgery for advanced ovarian cancer at Mass General for the past 11 years; the study included almost 500 women. We found that overall, these patients have a one in ten chance of being readmitted within 30 days after surgery. Most commonly this was due to a wound infection, but there were a variety of other reasons. Surprisingly, elderly and sick patients were no more likely to be readmitted than younger, healthier women. In fact, the only predictor for readmission was having a complication with the initial surgery. For example, if a patient had a blood clot that travelled to their lungs in the initial postoperative period, their risk of readmission was three times higher than those that did not. Infections, re-operation, high blood loss and unplanned admission to the intensive care unit also predicted for readmission. In summary, for patients without complications the risk of readmission was 1 in 25. However, once a patient had two complications their risk of readmission rose to 1 in 3.

We are using the results of this study to create a "high risk" postoperative care bundle for our gynecologic-oncology patients to help reduce readmissions. This may occur in the form of nursing phone calls, extra resources for home, and earlier and more frequent doctor’s appointments. Our hope is that by looking back at previous cases, we will identify ways to reduce all preventable readmissions, helping our patients heal faster in the comfort of their home.

The study was published in the journal Gynecologic Oncology.