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.