Preventable electrolyte disturbances and anemia are associated with increased rates of readmission following minimally invasive esophagectomy

Michelle C Nguyen, MD1, Carl R Schmidt, MD, FACS2, Robert E Merritt, MD3, David S Strosberg, MD1, David B Renton, MD1, Lisa Graham, MSN, RN, RNBC2, Kristen Johnson, MHA2, Susan D Moffatt-Bruce, MD, PhD, FACS3. 1The Ohio State University Wexner Medical Center, 2The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center, 3Richard M. Ross Heart Hospital at The Ohio State University Wexner Medical Center

INTRODUCTION: Patients undergoing esophagectomy have a high rate of unplanned postoperative readmission. With reimbursements now linked to quality outcomes, hospital readmissions are being used as a surrogate indicator to gauge patient outcomes. Our objective was to identify pre-discharge variables associated with readmission following minimally invasive esophagectomy to elucidate potential pre-discharge countermeasures aimed at decreasing readmissions.

METHODS AND PROCEDURES: Patients who underwent minimally invasive esophagectomy at the James Cancer Hospital at Ohio State University Medical Center between 1/2012- 1/2014 were identified and patient medical records were reviewed. Demographics, principle diagnosis, comorbidities, perioperative events, lab values at discharge, and 30-day readmission rate were collected. Fisher's exact test and Kruskal-Wallis test were performed with the above variables to evaluate for statistically significant risk factors for unplanned hospital readmission.

RESULTS: 51 patients underwent minimally invasive esophagectomy during the study period. 12 (23.5%) patients were readmitted within 30 days of discharge. 50% of readmitted patients had a diagnosis code for anemia during their initial hospitalization. Readmitted patients had lower magnesium, potassium and phosphate levels and higher RBC distribution levels at the time of discharge compared to non-readmitted patients (p = 0.051, 0.044, 0.027, 0.030 respectively). All other patient demographics, comorbidities, perioperative diagnoses and lab values were not statistically significant.

CONCLUSIONS: In this patient review, hypomagnesemia, hypokalemia, hypophosphatemia and anemia were strong, independently associated risk factors for increased rates of hospital readmission following minimally invasive esophagectomy. Actionable pre-discharge targets need to be created and implemented to optimize patients prior to discharge to reduce 30-day readmission.

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