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Unplanned Hospital Visits and Readmission After Surgery

Key findings

Approximately 14% to 28% of people with cancer who have breast, colorectal, lung or prostate surgery have an unplanned hospital visit following surgery. Cancer Care Ontario is actively monitoring Ontario’s hospitals in an effort to improve surgery quality in Ontario.

Why is this important to Ontarians?

An unplanned visit takes place when a patient returns to the emergency department or is readmitted directly to the hospital within 30 days of a cancer surgery. Looking at unplanned visits after cancer surgery gives us insight into complications and adverse events following cancer surgeries.

Some complications after cancer surgery may require the patient to return to the hospital for unscheduled visits, but others may be appropriately managed in different ways. Common problems include bleeding, infection, pain and slow recovery of other body functions.1

See Unplanned Hospital Visits After Surgery Methodology for technical information.

Report date: May 2019

Data sources: Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), Canadian Institute for Health Information’s National Ambulatory Care Reporting System (CIHI-NACRS)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Report date: May 2019

Data sources: Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), Canadian Institute for Health Information’s National Ambulatory Care Reporting System (CIHI-NACRS)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 1. Percentage of patients who had breast, colorectal, lung or prostate surgery for cancer and an unplanned hospital visit (emergency department visit or hospital readmission) within 30 days after surgery, 2014 to 2017
  Breast Colorectal Prostate Lung
2014 15.10 23.50 26.90 23.20
2015 13.80 22.70 24.80 24.50
2016 14.10 23.90 24.40 24.40
2017 13.90 21.90 27.90 25.30

Report date: May 2019

Data sources: Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), Canadian Institute for Health Information’s National Ambulatory Care Reporting System (CIHI-NACRS)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 2. Percentage of patients who had breast, colorectal, lung or prostate surgery for cancer and an unplanned emergency department visit or who were readmitted within 30 days after surgery, 2017
  % Unplanned ED Visits % Unplanned Readmissions
Breast 10.40 3.50
Colorectal 12.70 9.20
Prostate 24.70 3.20
Lung 17.40 7.90

Report date: May 2019

Data sources: Canadian Institute for Health Information’s Discharge Abstract Database (CIHI-DAD), Canadian Institute for Health Information’s National Ambulatory Care Reporting System (CIHI-NACRS)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Results

  • The percentage of patients who visited the emergency department or were readmitted to hospital within 30 days following cancer surgery varied by disease site. Rates have remained fairly stable from 2014 to 2017.
  • The provincial average of patients who visited the hospital within 30 days after cancer surgery in 2017 was 14% for breast cancer, 22% for colorectal cancer, 28% for prostate cancer and 25% for lung cancer.
  • Prostate cancer patients had the highest rate of emergency department visits of the 4 disease sites (25%), but the lowest readmission rate.
  • Colorectal cancer patients had the highest readmission rate (9%) after cancer surgery.

Opportunities

  • Why do patients return to the emergency department after cancer surgery? This question represents a major quality improvement focus for the Surgical Oncology Program this year. The program is working closely with experts on each disease site to investigate the reasons.
  • Potential areas for improvement to reduce unplanned emergency department visits following cancer surgery include:
    • improvements in home care
    • post-operative nursing support by telephone
    • improved maintenance of contact between the patient and the treatment team after discharge (electronic, telephone, etc.)
    • improved patient education

For more information

For more information about the Surgical Oncology Program, visit the Surgical Oncology Program on Cancer Care Ontario’s website.

References

1. A Guide to Cancer Surgery [Internet]. American Cancer Society; c2018 [cited 2018 Jan 24]. Available from: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/surgery/surgery-risks-and-side-effects