• Vaibhav Gupta, Lev Bubis, Biniam Kidane, Alyson L Mahar, Jolie Ringash, Rinku Sutradhar, Gail E Darling, and Natalie G Coburn.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: Vaibhav.Gupta@mail.utoronto.ca.
• J. Thorac. Cardiovasc. Surg. 2019 Sep 1; 158 (3): 934-942.e2.

ObjectiveReadmission following esophagectomy affects the patient experience, has important economic implications, and can be tied to hospital reimbursement. Ontario has regionalized thoracic centers; regionalized surgery may lower the readmission rate. We investigated whether surgery at regionalized thoracic centers is associated with reduced readmission following esophageal cancer resection.MethodsA retrospective, population-based cohort study (2002-2014) was conducted in Ontario, Canada (population 13.6 million). Adults with resected esophageal cancer were identified through the Ontario Cancer Registry. Multivariable regression was used to estimate the effect of surgery at a regionalized thoracic surgery center on readmission to any Ontario hospital within 90 days following discharge.ResultsOf 3670 patients, 27.9% were readmitted within 90 days of discharge (n = 1022). Median hospital length of stay was 12 days (interquartile range 9-20). The readmission rate at thoracic centers was similar to other hospitals (28.1% vs 27.1%, P = .57). The readmission rate did not change during the 13-year study period. Case-mix adjusted readmission rates varied from 17.6% to 35.2% even across thoracic centers and were not related to hospital volume or perioperative mortality. After adjusting for confounders, we found that surgery at a thoracic center was not significantly associated with readmission (odds ratio, 1.10; 95% confidence interval, 0.95-1.27, P = .22).ConclusionsSurgery at a designated thoracic surgery center did not reduce the risk of 90-day readmission following esophageal cancer resection, and readmission rates varied significantly even across thoracic centers. Our results suggest that despite universal, regionalized esophageal cancer care, there appears to be a minimum readmission threshold following esophagectomy that may be clinically necessary.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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