Impact of readmission location on survival after oesophagectomy and gastrectomy

Abstract

Background: Readmissions following oesophagogastric cancer surgery pose a substantial burden on healthcare systems and can adversely impact patient outcomes. While centralisation has improved postoperative mortality, concerns persist about the management of complex complications at peripheral hospitals. This study evaluates 90-day readmission rates following oesophagectomy and gastrectomy, distinguishing between index (hospital where primary surgery was performed) and non-index (peripheral hospital) readmissions. Secondary objectives include identifying risk factors for readmission and assessing the impact of readmission location on long-term survival.

Methods: A retrospective single-centre analysis was conducted on patients undergoing oesophagectomy or gastrectomy between 2011 and 2024. The primary outcome was unplanned readmission within 90 days of discharge. Multivariable logistic regression identified readmission risk factors. Survival analysis was conducted using Kaplan-Meier and Cox regression models.

Results: Of 881 patients (571 oesophagectomy, 310 gastrectomy), readmission rates were 26.1 % and 24.2 %, respectively. Risk factors for readmission included non-severe anastomotic leaks (OR 2.93; P = 0.004) and severe complications (OR 2.19; P = 0.003) for oesophagectomy, and prolonged hospital stay for gastrectomy (OR 1.04; P < 0.001). Protective factors included severe respiratory complications (OR 0.48; P = 0.024) and severe complications in gastrectomy patients (OR 0.33; P = 0.036). Index readmission was associated with improved survival on univariable analysis only.

Conclusion: Complication-readmission patterns vary by procedure type. While the survival benefit of index readmission remains unclear, our results highlight the importance of structured postoperative care to mitigate postoperative morbidity. Further research should identify complications best managed at tertiary centres to guide targeted readmission pathways.

Keywords: Centralisation; Gastrectomy; Oesophagectomy; Readmission.