Thirty-day readmission in patients with brain cancer and venous thromboembolism: A nationwide analysis using the national readmissions database

Abstract

Abstract Background: Venous thromboembolism (VTE) is a common and life-threatening complication in patients with brain cancer. However, little is known about the predictors and consequences of 30-day readmissions in this population. Using a nationally representative administrative database, we aimed to identify both patient and hospital-level factors that predict early readmission and to characterize the clinical and economic burden associated with these readmissions, including their impact on in-hospital mortality, length of stay (LOS), and hospitalization costs. Methods: We conducted a retrospective cohort study using the 2016–2017 Nationwide Readmissions Database (NRD), which is a weighted and stratified dataset representative of hospital discharges across the U.S. We included adults (≥18 years) with a principal or secondary ICD-10-CM diagnosis of brain cancer (C71.x, C7931) and concurrent VTE who were admitted non-electively and discharged by November. The primary outcome measured was the rate of 30-day all-cause unplanned readmission. Secondary outcomes included in-hospital mortality, LOS, and total hospitalization charges (adjusted for inflation to 2017 USD). To ensure national representativeness, we incorporated complex survey design elements (weights, strata, clustering). Multivariable survey-weighted logistic regression was used to identify independent predictors of readmission. Results: Among 21,669 weighted index hospitalizations that met the inclusion criteria, we found that 3,515 patients were readmitted, resulting in a 30-day readmission rate of 16.2% (95% CI: 15.4-17.1). The mortality rates during index and readmission hospitalizations were 14.0% (n=3,033) and 15.0% (n=552), respectively. Readmitted patients experienced considerable healthcare use, with a median LOS of 4 days (IQR: 2-7) and median charges of $36,305 (IQR: $19,815-$68,287). In our adjusted models, discharge to a non-home setting from the index hospitalization was significantly associated with lower odds of readmission (OR 0.41, 95% CI: 0.26–0.65; p < 0.001). Notably, no other demographic, hospital-level, or comorbidity variables—including age, sex, income, or common comorbidities (from the Elixhauser Index)—were found to be independently associated with 30-day readmission. A longer index LOS (>4 days) showed a non-significant trend toward an increased risk of readmission (OR 1.44, 95% CI: 0.82-2.51). Conclusions: Thirty-day readmissions are frequent and have serious clinical implications for patients with concurrent brain cancer and VTE. The national mortality rate approaches 15% during both index and readmission hospitalizations. Contrary to initial expectations, most demographic, clinical, and hospital-level factors did not independently correlate with readmission risk. However, discharge to non-home settings, which may indicate access to rehabilitation or palliative services, was associated with significantly lower readmission rates. These findings highlight the need for tailored discharge planning and effective post-acute care coordination to improve outcomes for this high-risk neuro-oncologic population.