Study: Readmissions due to post-discharge complications

According to a study recently published in the Journal of the American Medical Association (JAMA), readmissions in the first 30 days after surgery were associated with new post-discharge complications related to the surgical procedure and not to a worsening or mismanagement of conditions the patient already had while hospitalized for surgery.

As a Clinical Scholar at the American College of Surgeons (ACS), Ryan P. Merkow, MD, MS, and colleagues examined the reasons, timing, and factors associated with unplanned postoperative hospital readmissions within 30 days after surgery. The study reviewed data from patients undergoing surgery at hospitals participating in the ACS National Surgical Quality Improvement Program (ACS NSQIP®), January through December 2012. Readmission rates and reasons were assessed for all surgical procedures and for six representative operations: bariatric procedures, colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass.

Readmission as a quality and cost-containment metric is a major issue for hospitals, clinicians, and policymakers. Financial penalties for readmission have been expanded beyond medical conditions to include surgical procedures. Understanding the causes of readmissions could help direct future surgical quality improvement efforts and policy decisions designed to reduce surgical readmission rates.

The unplanned 30-day readmission rate for 498,875 operations was 5.7 percent. For the individual procedures, the rate of readmission ranged from 3.8 percent after hysterectomy to 14.9 percent after lower extremity vascular bypass. The most common reason for unplanned readmission was surgical site infection (19.5 percent), ranging from 11.4 percent after bariatric surgery to 36.4 percent after lower extremity vascular bypass.

Co-authors of the study, which has received prominent media coverage, include Karl Y. Bilimoria, MD, MS, FACS, ACS Faculty Scholar and director, Surgical Outcomes and Quality Improvement Center, Northwestern University, Chicago, IL; and Clifford Y. Ko, MD, MS, MSHS, FACS, Director of ACS NSQIP and the Division of Research and Optimal Patient Care. View the study in JAMA.

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