Risk Factors for 30-Day Hospital Readmission among General Surgery Patients

Abstract

Background Hospital readmission within 30-days of an index hospitalization is receiving increased scrutiny as a marker of poor quality patient care. This study identifies factors associated with 30-day readmission following General Surgery procedures. Study Design Using standard National Surgical Quality Improvement Project (NSQIP) protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient General Surgery procedures at a single academic center between 2009 and 2011. Data were merged with our institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted. Univariate and multivariate analysis was utilized to identify risk factors associated with 30-day readmission. Results 1442 General Surgery patients were reviewed. 163 (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal complaint/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound (p<0.05 for all variables). Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (OR 4.20, 95% CI 2.89–6.13). Conclusions Risk factors for readmission after General Surgery procedures are multi-factorial; however, postoperative complications appear to drive readmissions in surgical patients. Taking appropriate steps to minimize postoperative complications will decrease postoperative readmissions.

Readmissions after general surgery: a prospective multicenter audit

“…we have avoided some factors identified in previous readmission studies, including socioeconomic issues and chronic diseases 10,11 . However, these studies often reviewed one type of operation [12][13][14] or were undertaken on non-UK populations [14][15][16] . This might explain why they have not demonstrated the same significance in our cohort.…”

Past, present, and future of Emergency General Surgery in the USA

“…Approximately half of all patients undergoing EGS will have a postoperative complication 15. In 2015, a study was carried out using the California State Inpatient Database that showed that 5.9% of EGS patients were readmitted within 30 days of discharge with higher rates of readmission in patients on public insurance and those with higher baseline comorbidity status, longer lengths of index hospital stay, and discharge dispositions other than home 16.…”

Atrial Fibrillation and Cor Triatriatum Sinister: A Case Report

“…33,47 In addition to dose, prior anthracycline therapy, a history of mediastinal radiation, and elderly age are further risk factors for cardiotoxicity. 29,[45][46][47]49,50 Cytoskeletal …”

“…56 As noted previously, the cardiotoxicity of systemic therapies may become one of the most devastating consequences of the treatment itself, particularly when an additional comorbidity such as a history of coronary artery disease, hypertension, or smoking is added to the patient's active problem list (Table 1). 45,[56][57][58] …”

“…The cluster of therapies such as anthracycline-based chemotherapy, right-or left-sided RT, trastuzumab administration, and hormonal blockade with AIs may contribute to an increased incidence of CVD. [39][40][41][42][43][44][45][46][47][48]62,67,[153][154][155][156] In particular, there have been recent concerns calling for further investigation of targeted therapies used in combination with RT and the potential for long-term cardiovascular side effects. 92,147,154,157 Table 1 summarizes the potential longterm cardiovascular side effects of chemotherapy.…”