Postop complications are greatest risk for 30-day readmission

Sep 6 2012

By Sarah Guy, medwireNews Reporter

Postoperative complications, particularly gastrointestinal, are the greatest driver behind 30-day hospital readmissions, show study results involving data for over 1000 general surgery patients.

Certain complications increased readmission risk more than others, report the researchers, such as postoperative wound complications, which accounted for just over a quarter of the patients readmitted in the study.

However, the most significant independent risk factor for readmission is having any postoperative complication, which increases the risk by more than four times compared with having none, they write in the Journal of the American College of Surgeons.

"Understanding which postoperative complications carry larger risks will be helpful in determining how to allocate resources to prevent the complications and readmission after surgery," suggest John Sweeney, from Emory University School of Medicine in Atlanta, Georgia, USA, and colleagues.

Since US hospitals were made accountable for 30-day readmissions by the Affordable Care Act in 2012, "there is an intense focus on decreasing unnecessary surgical readmissions," explain Sweeney et al.

Their findings, from data on 1442 general surgery patients treated over a 2-year period, indicate a readmission rate of approximately 11% (n=163).

After controlling for factors including the presence of a preoperative open wound, preoperative sepsis, and pancreatectomy - which all significantly increased the risk for readmission - having at least one postsurgery complication increased the risk for readmission 4.2-fold, compared with having none.

Wound complications and having a blood transfusion within 72 hours of surgery were the most common complications among those patients who were readmitted, at 28.8% and 26.4%, respectively. Gastrointestinal problems (such as nausea) and surgical infections accounted for almost half of reasons for readmission, at 27.6% and 22.1%, respectively, while pancreatectomy had the highest readmission rate of all procedures, at 17.9%.

Patients with a preoperative stay longer than 24 hours were also a significant 1.87 times more likely to be readmitted to hospital within 30 days of their procedure than their peers whose stay was shorter.

"Decreasing complications will benefit the patient, the hospital, and the payer, and will improve quality of care," said Sweeney in a press statement. "It will decrease length-of-stay and decrease hospital readmissions."

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