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Fragmentation of postoperative care after surgical management of ovarian cancer at 30-days and 90-days.

BACKGROUND: Fragmentation of care, wherein a patient is discharged from an index hospital and undergoes an unexpected readmission to a non-index hospital, is associated with increased risk of adverse outcomes. Fragmentation is not well characterized in ovarian cancer.

OBJECTIVE: The objective of this study was to assess risk factors and outcomes associated with fragmentation of care among women who undergo surgical treatment of ovarian cancer.

STUDY DESIGN: The Nationwide Readmission Database was used to identify all-cause 30-day and 90-day postoperative readmissions following surgical management of ovarian cancer between 2010-2014. Postoperative fragmentation was defined as readmission to a hospital other than the index hospital of the initial surgery. Multivariable regression analyses were used to identify predictors of fragmentation in both 30-day and 90-day readmissions. Similarly, multivariable models were developed to determine the association between fragmentation and mortality among women who were readmitted.

RESULTS: A total of 10,445 patients (13.3%) were readmitted at 30-days and 14,124 patients (18.0%) were readmitted at 90-days. Of these, there was a 20.8% and 25.7% rate of postoperative care fragmentation for 30-day and 90-day readmissions, respectively. Patient risk factors associated with fragmented postoperative care included Medicare insurance, lower income quartiles, and non-routine discharge to facility. Hospital factors associated with decreased risk of fragmentation included operation at a metropolitan teaching hospital, and performance of extended procedures. Cost and length of stay for the readmission were similar among those who had fragmented and non-fragmented readmissions at both 30 and 90-days. While there was no association between mortality and fragmentation for patients readmitted within 30-days (OR=1.19; 95% CI, 0.93-1.51), patients who had a fragmented readmission at 90-days were 22% more likely to die than those readmitted at 90-days to their index hospital (OR=1.22; 95% CI, 1.00-1.49) CONCLUSION: Fragmentation of care is common in women with ovarian cancer who require postoperative readmission. Fragmented postoperative care is associated with an increased risk of mortality among women readmitted within 90-days of surgery.

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