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

Anh T. Butz, Michel El Alam, William P. Irvin Jr., Dale W. Stovall


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 (RIp) and before discharge (RId), and the difference between these values was calculated (RIc). 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 RId was significantly different between groups, with median RId of 70 for readmitted subjects and 75.5 for controls (P = .029). Binomial regression of readmission on RI revealed an RId 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 RIp or RIc, 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.

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Journal of Hospital Administration

ISSN 1927-6990(Print)   ISSN 1927-7008(Online)

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