Underestimation of Unplanned Readmission after Colorectal Surgery: A National Analysis

Rattan, Rishi; Parreco, Joshua; Lindenmaier, Laurence B.; Yeh, D. Dante; Zakrison, Tanya L.; Pust, Gerd Daniel; Sands, Laurence R.; Namias, Nicholas

doi:10.1016/j.jamcollsurg.2017.12.012

Cited by 25 publications

(20 citation statements)

References 28 publications

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“…Furthermore, risk factors for readmission to different hospitals are unique and include the index treatment at small and/or for‐profit hospitals. Similar findings have been noted in other works studying different‐hospital readmissions 3–6 …”

Section: Discussionsupporting

confidence: 92%

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Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Cioci

Kedar²,

Urréchaga

et al. 2021

BJOG

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Objective To quantify the proportion of postpartum venous thromboembolism (VTE) readmissions, including those that occur at different hospitals from index admission, and describe risk factors for this outcome. Design Retrospective observational study. Setting US hospitals included in the Nationwide Readmissions Database. Sample A total of 3 719 238 patients >14 years of age with a delivery‐associated hospitalisation in 2014. Methods Univariate analysis was performed to identify patient and hospital factors associated with readmissions. Significant factors were included in multivariate logistic regression to identify independent risk factors. Results were weighted for national estimates. Main outcome measures Readmission with VTE to both index and different hospitals at 30, 60 and 90 days. Results The VTE cumulative readmission rate was 0.053% (n = 1477), 0.063% (n = 1765) and 0.069% (n = 1938) at 30, 60 and 90 days, respectively. Patients were readmitted to different hospitals 31% of the time within 90 days. Risk factors for different hospital VTE readmission were unique and included younger age and initial admission to a small/medium‐sized hospital. Initial admission to a for‐profit hospital increased the likelihood of readmission to a different hospital. Conclusions Nearly one in three postpartum VTEs are missed by the current quality metrics, with significant implications for outcomes and quality. For‐profit hospitals have a significant portion of their VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. Tweetable abstract US analysis shows 1 in 3 readmissions for postpartum venous thromboembolism currently missed.

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Section: Discussionsupporting

confidence: 92%

“…Benchmarks are based on readmission to the same hospital, and are assumed to be both accurate and similar between different hospital types 2 . However, same‐hospital readmission rates have been demonstrated to be inaccurate and different‐hospital readmission rates vary by hospital type 3–6 …”

Section: Introductionmentioning

confidence: 99%

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Cioci

Kedar²,

Urréchaga

et al. 2021

BJOG

View full text Add to dashboard Cite

show abstract

“…9 Although late readmissions may be related to potentially targetable modifiable risk factors, this number is difficult to reduce, and takes many programs, such as the availability of outpatient intravenous fluids, home care, and the use of observation status among others. 10,11 Several governmental initiatives, driven by Centers for Medicare and Medicaid Services (CMS), have been initiated to help understand the root cause of, and curb, readmissions. The Hospital Value-Based Purchasing (HVBP) program financially incentivize hospitals that provide better outcomes and the Hospital Readmission Reduction Program (HRRP) reduces payments for hospitals with high readmission rates.…”

Section: Incentivizing Valuementioning

confidence: 99%

Health Care Policy and Outcomes after Colon and Rectal Surgery: What Is the Bigger Picture?—Cost Containment, Incentivizing Value, Transparency, and Centers of Excellence

Bhama

Holubar

Delaney

2019

Clinics in Colon and Rectal Surgery

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Early in the 21st century, the costs of health care in the United States have spiraled out of control, where the per capita spending is $9,237 per person—the highest in the world. By 2020, an estimated 20% of GDP will be spent on health care. The issue of cost and quality is now becoming a national crisis, with ∼50% of hospitals losing money on clinical operations, forcing closure of essential critical access hospitals, and forcing health care workers to relocate or change professions. This crisis will only worsen with the graying of America, as an estimated 17% of Americans will be over the age of 65 years by the year 2020. The policy and financial structures on which these changes are based are important factors of which practicing surgeons should be aware. This review discusses recent national health care policy reform and specific topics including cost-containment legislation, value-based incentives and penalties, transparency, and centers of excellence in colorectal surgery.

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“…The Nationwide Readmission Database arguably provides important insights from a national perspective 14,15 . Nevertheless, large reports from individual centres are indispensable since deriving from more homogeneous patient cohorts with both standardized preoperative care and discharge practice.…”

Section: Introductionmentioning

confidence: 99%

Temporal patterns of hospital readmissions according to disease category for patients after elective colorectal surgery

Grass

Crippa

Lovely

et al. 2020

Evaluation Clinical Practice

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Rationale The aim of this study was to identify temporal readmission patterns according to baseline disease categories to provide opportunities for targeted interventions. Methods Retrospective analysis of consecutive adult (≥18 years) patients who underwent elective colorectal resections (2011‐2017) at Mayo Clinic Rochester, MN. A prospective administrative database including patient demographics, procedure characteristics, discharge information and specifics on 30‐day readmissions (to index facility) including timing and reasons was utilized. The ICD‐9 codes were regrouped into the main pathologies Cancer, Crohn's disease (CD)/chronic ulcerative colitis (CUC), and diverticular disease. Results In total, 521 (7.2%) out of 7245 patients undergoing inpatient colorectal surgery were readmitted. In all increments of time from discharge (0‐2 days: 31.3% of all readmissions, 3‐7 days: 32.4% of all readmissions, 8‐14 days: 18% of all readmissions, and 15‐30 days: 18.3% of all readmissions), reasons for readmission differed significantly (all P < 0.001). Across all disease categories, early readmissions (within 2 days of discharge) were most likely due to ileus/obstruction (53.4% of early readmissions), whereas with 42.5%, infection was the most common cause for late readmissions (>7 days). Patients with home discharge were more likely to be readmitted earlier within the 30‐day observation period (P = 0.099), whereas patients with a longer length of index hospital stay (>7 days) were readmitted later (P = 0.080). Conclusions Reasons for readmission appear to be universal across different disease categories. Targeted educational and collaborative measures may help to mitigate the burden of hospital readmissions to index facilities.

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Underestimation of Unplanned Readmission after Colorectal Surgery: A National Analysis

Cited by 25 publications

References 28 publications

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Uncaptured rates of postpartum venous thromboembolism: a US national analysis

Health Care Policy and Outcomes after Colon and Rectal Surgery: What Is the Bigger Picture?—Cost Containment, Incentivizing Value, Transparency, and Centers of Excellence

Temporal patterns of hospital readmissions according to disease category for patients after elective colorectal surgery

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