Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients

Keller, Deborah S.; Swendseid, Brian; Khorgami, Zhamak; Champagne, Bradley J.; Reynolds, Harry L.; Stein, Sharon L.; Delaney, Conor P.

doi:10.1016/j.amjsurg.2013.09.008

Cited by 19 publications

(30 citation statements)

References 10 publications

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“…Finally, the current study included index trauma admissions only from hospitals with a statewide Trauma Center designation, whereas the Spector study included all acute care hospitals. However, the M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 11 Washington State Trauma System is unique in that the majority of acute care facilities in the state (81 out of 93) have a Trauma Center designation and were therefore included in this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital readmission is a significant contributor to this financial strain (10,11), and it has also been posited as a measure of quality of care (12,13). As a result of these concerns, in 2012 the Affordable Care Act instituted the Hospital Readmissions Reduction Program (HRRP), M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 by older adult trauma, and in order to inform further policy discussion, we undertook this study with the following aims: 1) Determine the proportion of older patients who require unplanned readmission following hospitalization for trauma, as well as risk factors for these readmissions;…”

mentioning

confidence: 99%

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Risk Factors for Unplanned Readmissions in Older Adult Trauma Patients in Washington State: A Competing Risk Analysis

Fawcett

Flynn-OʼBrien

Shorter

et al. 2015

Journal of the American College of Surgeons

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk Factors for Unplanned Readmissions in Older Adult Trauma Patients in Washington State: A Competing Risk Analysis

Fawcett

Flynn-OʼBrien

Shorter

et al. 2015

Journal of the American College of Surgeons

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“…While clinical care pathways have proven as an effective means to reduce costs and LOS, 18, 19 an essential component of these pathways needs to be a focus on addressing complications and patients at risk for readmission. 11, 20 Evaluation of such interventions has yet to be shown. These questions are essential to address with further research, as the financial impact of reducing even a small proportion of these readmissions would be significant.…”

Section: Discussionmentioning

confidence: 99%

Hospital Readmissions

Brown

Burgess

et al. 2014

Annals of Surgery

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OBJECTIVES To evaluate readmission rates and associated factors in order to identify potentially preventable readmissions. SUMMARY BACKGROUND DATA The decision to penalize hospitals for readmissions is compelling healthcare systems to develop processes to minimize readmissions. Research to identify preventable readmissions is critical to achieve these goals. METHODS We performed a retrospective review of University HealthSystem Consortium database for cancer patients hospitalized from 1/2010–9/2013. Outcome measures were 7-, 14-, and 30-day readmission rates and readmission diagnoses. Hospital and disease characteristics were evaluated to evaluate relationships with readmission. RESULTS 2,517,886 patients were hospitalized for cancer treatment. Readmission rates at 7, 14, and 30 days were 2.2%, 3.7%, and 5.6%. Despite concern that premature hospital discharge may be associated with increased readmissions, a shorter initial length of stay predicted lower readmission rates. Furthermore, high volume centers and designated cancer centers had higher readmission rates. Evaluating institutional data (N=2517 patients) demonstrated that factors associated with higher readmission rates include: discharge from a medical service, site of malignancy, emergent primary admission. When examining readmission within 7 days for surgical services, the most common readmission diagnoses were infectious causes (46.3%), nausea/vomiting/dehydration (26.8%), and pain (6.1%). CONCLUSIONS A minority of patients following hospitalization for cancer-related therapy are readmitted with potentially preventable conditions such as nausea, vomiting, dehydration and pain. However, most factors associated with readmission cannot be modified. Additionally, high volume centers and designated cancer centers have higher readmission rates, which may indicate that readmission rates may not be an appropriate marker for quality improvement.

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“…Postoperative readmission after colectomy is common, and the estimated cost of readmission is nearly $13,000 (see Table 2) [31]. Several large studies have examined readmission rates after colectomy.…”

Section: Colorectal Readmissionsmentioning

confidence: 99%

“…Of those that were deemed preventable, dehydration was the most common readmission diagnosis. One study defined preventable as a superficial site infection or dehydration [31] while another deemed those patients readmitted within 7 days of discharge as a target for improvement [26].…”

Section: Defining Preventablementioning

confidence: 99%