Variation in Surgical-Readmission Rates and Quality of Hospital Care
What are patterns of surgical readmissions among Medicare patients, hospital characteristics associated with higher surgical readmission rates, and relationships between measures of surgical quality (e.g., perioperative mortality) and readmission rates?
The authors used national Medicare data to calculate 30-day readmission rates after the following six major surgical procedures: coronary artery bypass grafting (CABG), pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. Statistical analyses were used to characterize relationships between readmission rates and structural characteristics of hospitals (hospital size, teaching status, region, ownership, and proportion of patients living below the federal poverty line) and three well-established measures of surgical quality (Hospital Quality Alliance surgical score, procedure volume, and 30-day surgical mortality).
The median risk-adjusted composite readmission rate at 30 days was 13.1% (interquartile range, 9.9-17.1). Hospitals with the highest procedure volumes had a lower composite readmission rate than did hospitals with the lowest procedure volumes (12.7% vs. 16.8%, p < 0.001). Hospitals with the lowest surgical mortality rates had significantly lower readmission rates, compared to those with the highest mortality rates (13.3% vs. 14.2%, p < 0.001). Volume and mortality remained independently associated with risk-adjusted composite readmission rates in the final multivariable model, which accounted for both hospital quality measures and hospital structural characteristics.
The authors concluded that high-performing hospitals, as assessed by procedure volume and 30-day mortality rates, have lower 30-day surgical readmission rates.
The current analysis suggests that measures of surgical quality are associated with surgical readmission rates. Future studies should build on the clinical significance of these findings and help characterize why higher-volume or lower-mortality hospitals have lower readmission rates.
Keywords: Arthroplasty, Replacement, Hip, Risk, Endovascular Procedures, Hospital Mortality, Patient Readmission, Cardiovascular Diseases, Colectomy, Medicare, Coronary Artery Bypass, Aortic Aneurysm, Abdominal, Poverty, United States
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