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Author Notes:

Correspondence: John F. Sweeney, MD, W. Dean Warren Distinguished Professor of Surgery, Chief, Division of General and Gastrointestinal Surgery, Chief Quality Officer, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road NE, Suite H-124, Atlanta, GA 30322; Phone: 404-727-1540; Fax: 404-712-5416; Email: jfsween@emory.edu

Authors' Contributions: Drs. Kassn and Owen contributed equally to this work.

Study conception and design: Kassin, Owen, Perez, Leeds, Cox, Schnier, Sadiraj, Sweeney

Acquisition of data: Kassin, Perez, Sweeney

Analysis and interpretation of data: Kassin, Owen, Perez, Leeds, Cox, Schnier, Sadiraj, Sweeney

Drafting of manuscript: Kassin, Owen, Perez, Sweeney

Critical revision: Kassin, Owen, Perez, Leeds, Cox, Schnier, Sadiraj, Sweeney

Disclosures: There are no conflicts of interest to report.

Subject:

Research Funding:

This work was supported in part by National Institutes of Health/National Institute of Aging Grant 1RC4AG039071 (to Drs. Sweeney and Cox).

Keywords:

  • Postoperative Readmission
  • Complications
  • Risk Factors
  • General Surgery

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

Tools:

Journal Title:

Journal of The American College of Surgeons

Volume:

Volume 215, Number 3

Publisher:

, Pages 322-330

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2012 American College of Surgeons

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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