In a study that could improve outcomes for patients who have undergone surgery for cancer that has metastasized to the brain, a team of researchers at Baptist Health’s Miami Cancer Institute has defined those factors that make these patients more likely to be readmitted to the hospital within 30 days of their surgery. Better awareness of these risk factors could potentially reduce readmissions substantially, both improving patient care and outcomes and lowering healthcare costs.
The results of the study, “Factors Associated with Unplanned Readmissions and Costs Following Resection of Brain Metastases in the United States ,” were published recently in Nature Scientific Reports, a leading multidisciplinary science journal.
The research team at Miami Cancer Institute  was led by senior author Rupesh Kotecha, M.D. , chief of Radiosurgery and director of CNS Metastasis at the Institute. More than 200,000 cases of brain metastases are diagnosed in the U.S. each year, and approximately one in six of those who go on to have brain surgery are hospitalized again within 30 days. In addition to prolonging care and patient discomfort, the extrapolated costs associated with the additional hospital days add up to more than $269 million a year nationally. Readmission could also delay further cancer treatment.
“We looked at almost 45,000 surgeries from across the U.S., with about half of all hospitals represented in the data,” Dr. Kotecha said. “Other types of surgeries have seen reduced readmissions in recent years but unplanned readmissions for brain metastases has remained steady. Being able to better predict who has a higher chance of being readmitted could be a game-changer.”
From the study, the Institute team was able to identify the most common high-risk factors. Patients more likely to be readmitted were those with more co-morbidities (particularly those with more than three co-morbidities); longer lengths of stay (especially stays of five days or more); complications such as an infection; patients who were older and male. Having Medicaid and being admitted to a metropolitan teaching hospital also were associated with higher risk. While any cancer can spread to the brain, according to the American Cancer Society, the most common are lung, breast and melanoma.
“The key now is that we need to prevent avoidable readmissions by focusing on this high-risk population,” Dr. Kotecha said. “Depending upon the risk factors, we should consider discharging them to a rehabilitation center rather than home, having clinical staff check in with them more frequently after surgery rather than waiting for the typical follow-up appointment, or even offering other interventions rather than surgery.”
While some risk factors are modifiable, such as post-operative infection, Dr. Kotecha said, others, such as age, are not. Advances in technologies in recent years have given physicians more options when it comes to treating brain cancers, however. For those at extremely high risk, more minimally invasive procedures may be considered, as well as treatments such as radiosurgery, which is targeted radiation. The Institute also offers numerous clinical trials for this patient population with innovative strategies for brain metastasis management.
The next step in advancing the study on readmissions following resection of brain metastases, Dr. Kotecha said, is continued research to verify and further refine the risk stratification model developed by the Institute. Hospitals can then plan strategies to best address those at highest risk.