Study Finds Surgical Readmissions Reflect Postdischarge Complications

Readmissions after surgery may be associated with new postdischarge complications related to the surgical procedure and not with “exacerbation of prior index hospitalization complications,” according to a study published Feb. 3 in the Journal of the American Medical Association.

The study, led by Ryan P. Merkow, MD, MS, Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, examined the reasons, timing, and factors associated with unplanned postoperative hospital readmissions within 30 days after surgery. The study included data from patients undergoing surgery at one of 346 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program between January and 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.

Results showed that 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 (SSI) (19.5 percent). The most common reason for readmission after bariatric surgery was ileus or obstruction (24.5 percent), and ileus or obstruction was the second most common reason for readmission overall (10.3 percent) and for colectomy or proctectomy, ventral hernia repair, and hysterectomy. 

The authors conclude that “Understanding the underlying reasons for readmission, the timing, and the associated factors should help hospitals to undertake targeted quality improvement initiatives to reduce readmissions. However, surgical readmissions mostly reflect postdischarge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI. Efforts should focus on reducing complication rates overall than simply those that occur after discharge, and this will subsequently reduce readmission rates as well. Readmissions after surgery may not be an appropriate measure for pay-for-performance programs but rather better suited as measure for hospitals to track internally.”

In a related editorial comment, Lucian L. Leape, MD, of the department of Health Policy and Management, Harvard School of Public Health, Boston, MA, notes “collaboration is [a] powerful method for achieving sustained system changes. A proven mechanism for this is regional collaboratives, in which teams from multiple institutions focus on a single problem, making improvements, and meet periodically to learn from experts and from each other... The findings reported by Merkow et. al. provide an unprecedented opportunity to apply these lessons to make substantial reductions in surgical complications.”

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