A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Coimbra, Raúl; Allison-Aipa, Timothy; Zachary, Bishoy; Firek, Matthew; Edwards, Sara L.

doi:10.1097/ta.0000000000003804

Cited by 6 publications

(3 citation statements)

References 17 publications

(119 reference statements)

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“…Recent evidence proposes that unmodifiable patient and disease-related factors may drive hospital readmissions in emergency general surgery. 39 Hence, it was suggested that readmissions might be reduced by implementing postdischarge surveillance systems leveraging telehealth and in-person outpatient care provided by surgeons, primary care providers, and appropriate specialists. These postdischarge interventions will require data collection and analytic mechanisms for episodes of care that can document and collapse information over many months to years.…”

Section: Discussionmentioning

confidence: 99%

“…The readmission rate in our study was 15.1% for the aggregate cohort, and we found a substantial number of patients who required additional operations or interventions. Recent evidence proposes that unmodifiable patient and disease-related factors may drive hospital readmissions in emergency general surgery 39 . Hence, it was suggested that readmissions might be reduced by implementing postdischarge surveillance systems leveraging telehealth and in-person outpatient care provided by surgeons, primary care providers, and appropriate specialists.…”

Section: Discussionmentioning

confidence: 99%

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Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative

Hemmila,

Neiman,

Hoppe

et al. 2024

J Trauma Acute Care Surg

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Background Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements. Methods We collected data at ten hospitals from 7/2019-12/2022. Five cohorts were defined: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes investigated included operative vs. non-operative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. Multivariable risk adjustment accounted for variations in demographic, comorbid, anatomic, and disease traits. Results Of the 19,956 emergency general surgery patients, 56.8% were female and 82.8% were white, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5% (95% CI, 3.2-3.7), morbidity 27.6% (95% CI, 27.0-28.3), and the readmission rate was 15.1% (95% CI, 14.6-15.6). Operative management varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Significant differences in outcomes between hospitals were observed with high- and low-outlier performers identified after risk adjustment in the overall cohort for mortality, morbidity, and readmissions. The use of a Gastrografin challenge in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. In patients who underwent initial non-operative management of acute cholecystitis, 51.5% had a cholecystostomy tube placed. The cholecystostomy tube placement rate ranged from 23.5% to 62.1% across hospitals. Conclusions A multihospital emergency general surgery collaborative reveals high morbidity with substantial variability in processes and outcomes among hospitals. A targeted collaborative quality improvement effort can identify outliers in emergency general surgery care and may provide a mechanism to optimize outcomes. Level of Evidence III, therapeutic/care management

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative

Hemmila,

Neiman,

Hoppe

et al. 2024

J Trauma Acute Care Surg

View full text Add to dashboard Cite

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“…In agreement with recent literature, most factors related to readmission in this study are non-modifiable (ASA score, stomal placement etc.). Still, when zooming in on the specific mechanism behind each readmission, we find that they often are multifactorial and in several instances, preventable [ 8 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

í Soylu,

Kokotovic,

Gögenur

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Major emergency abdominal surgery is associated with severe in-hospital complications and loss of performance. After discharge, a substantial fraction of patients are readmitted emergently; however, limited knowledge exists of the long-term consequences. The aim of this study was to examine the risks and causes of short-term (30-day) and long-term (180-day) readmission among patients undergoing major emergency abdominal surgery. Methods This study included 504 patients who underwent major emergency abdominal surgery at the Zealand University Hospital between March 1, 2017, and February 28, 2019. The population was followed from 0 to 180 days after discharge, and detailed readmission information was registered. A Cox proportional hazards model was used to examine the independent risk factors for readmission within 30 and 180 days. Results From 0 to 30 days after discharge, 161 (31.9%) patients were readmitted emergently, accumulating to 241 (47.8%) patients within 180 days after discharge. The main reasons for short-term readmission were related to the gastrointestinal tract and surgical wounds, whereas long-term readmissions were due to infections, cardiovascular complications, and abdominal pain. Stomal placement was an independent risk factor for short-term readmission, whereas an ASA score of 3 was a risk factor for both short-term and long-term readmission. Conclusion Close to 50% of all patients who underwent major emergency abdominal surgery had one or more emergency readmission within 180 days of discharge, and these data points towards the risk factors involved.

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Characterizing trauma patients with delays in orthopedic process measures

Gohel,

Khambete,

Gerhardinger

et al. 2024

J Trauma Acute Care Surg

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Introduction Early operative intervention in orthopaedic injuries is associated with decreased morbidity and mortality. Relevant process measures (e.g. femoral shaft fixation <24 hours) are used in trauma quality improvement programs to evaluate performance. Currently, there is no mechanism to account for patients who are unable to undergo surgical intervention (i.e. physiologically unstable). We characterized the factors associated with patients who did not meet these orthopaedic process measures. Methods A retrospective cohort study of patients from 35 ACS-COT verified Level 1 and Level 2 trauma centers was performed utilizing quality collaborative data (2017-2022). Inclusion criteria were adult patients (≥18 years), ISS ≥5, and a closed femoral shaft or open tibial shaft fracture classified via the Abbreviated Injury Scale version 2005 (AIS2005). Relevant factors (e.g. physiologic) associated with a procedural delay >24 hours were identified through a multivariable logistic regression and the effect of delay on inpatient outcomes was assessed. A sub-analysis characterized the rate of delay in “healthy patients” Results We identified 5,199 patients with a femoral shaft fracture and 87.5% had a fixation procedure, of which 31.8% had a delay, and 47.1% of those delayed were “healthy.” There were 1,291 patients with an open tibial shaft fracture, 92.2% had fixation, 50.5% had an irrigation and debridement and 11.2% and 18.7% were delayed, respectively. High ISS, older age and multiple medical comorbidities were associated with a delay in femur fixation, and those delayed had a higher incidence of complications. Conclusions There is a substantial incidence of surgical delays in some orthopaedic trauma process measures that are predicted by certain patient characteristics, and this is associated with an increased rate of complications. Understanding these factors associated with a surgical delay, and effectively accounting for them, is key if these process measures are to be used appropriately in quality improvement programs. Level of Evidence Level III; Therapeutic/Care Management

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A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Abstract: Factors related to EGS 30-d readmissions are mostly unmodifiable. However, rigorous CQI, implementation of standardized intra and postoperative measures (ERAS) and a post-discharge surveillance system may decrease EGS readmissions. #EGS #EGSquality

Cited by 6 publications

References 17 publications

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative

Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

Characterizing trauma patients with delays in orthopedic process measures

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