The Rothman Index: Assessing risk for 30-day readmission in gynecologic oncology service patients

Abstract

Background: The Rothman Index (RI) is a previously validated, continuously computed score derived from 26 clinical measures that assesses a patient's clinical status. It has been used as a prognostic indicator in the intensive care setting and has been incorporated into the electronic medical record. This study was designed to determine its utility in assessing 30-day readmission rates in postoperative gynecologic oncology service patients.

Methods: In this retrospective case-control study, gynecologic oncology service surgical patients readmitted within 30 days of discharge (cases) were matched 1:2 by procedure, diagnosis, age and comorbidities to non-readmitted gynecologic oncology surgical patients (controls). All procedures were performed at one center by a single surgeon. Rothman Index values were obtained immediately postoperative (RI_p) and before discharge (RI_d), and the difference between these values was calculated (RI_c). Rothman Index scores were compared between cases and controls.

Results: In total, 24 cases were matched to 48 controls. The mean age of all study participants was 56 years. The RI_d was significantly different between groups, with median RI_d of 70 for readmitted subjects and 75.5 for controls (P = .029). Binomial regression of readmission on RI revealed an RI_d of 58.9 or less was associated with at least 50% likelihood of readmission (P = .017). Cases and controls did not significantly differ based on RI_p or RI_c, and were similar with respect to risk factors including diabetes, smoking, and BMI.

Conclusion: Delaying discharge for patients with RI below a designated threshold may reduce gynecologic oncology postoperative readmission rates.