Association of hospital teaching characteristics with readmission and complication outcomes among patients receiving radiotherapy and brachytherapy for breast cancer: A Nationwide Readmissions Database Analysis

Abstract Background Radiotherapy and brachytherapy are common treatments for breast cancer, but few studies have examined the impact of hospital characteristics on patient outcomes. This study evaluated the influence of hospital teaching status on prognosis and healthcare resource utilization (HCRU) in breast cancer patients receiving these therapies. Method We conducted a retrospective cohort analysis using the US Nationwide Readmissions Database (NRD), including female breast cancer patients aged ≥ 18 years who received brachytherapy or radiotherapy between January 1, 2016, and December 30, 2021. Logistic regression models assessed the association between hospital teaching status and outcomes such as radiation-related complications, in-hospital mortality, and readmission rates. Results Of 9,030 patients, 7,177 (79.5%) were treated at teaching hospitals. Teaching hospital patients were younger, had higher rates of metastatic cancer, and were less likely to undergo breast-conserving surgery or mastectomy. In-hospital mortality was higher for radiotherapy than brachytherapy (4.2% vs 0.3%), with no significant difference between hospital types. Radiation-related complications were more frequent in non-teaching hospitals for both radiotherapy (OR: 1.11 [1.01, 1.21]) and brachytherapy (OR: 1.59 [0.97, 2.62]). Radiotherapy readmission rates were lower at non-teaching hospitals at 30 (OR: 0.82 [0.70, 0.95]) and 90 days (OR: 0.84 [0.74, 0.95]), with reduced costs and shorter length of stay. Conclusion Significant differences in prognosis and HCRU exist for breast cancer patients undergoing radiotherapy at teaching versus non-teaching hospitals, warranting further investigation.