Surgical readmissions most commonly linked to postoperative complications

1. Surgical site infections (SSI) and obstruction or ileus were found to be the most common causes of both early and late surgical readmissions.

2. The timing of surgical readmissions was not associated with particular postoperative day.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In 2012, the Hospital Readmissions Reduction Program was established via an added section to the Social Security Act. This program requires the Centers for Medicare and Medicaid (CMS) to reduce payments to hospitals with excessive readmission rates. The decision was controversial due to the immense variability among hospitals, patient populations, and complexity of procedures. While initially concentrating on myocardial infarction, heart failure, and pneumonia readmissions, the program has been expanded to include all surgical readmissions.

The purpose of this study was to understand the etiology of surgical readmissions as well as the timing of such readmissions. It was found that postoperative complications, such as surgical site infections and ileus, were the most common reasons for both early and late surgical readmissions. Further, readmissions were not linked to a specific postoperative day. A major strength of the study lies in the authors gathering prospective data from The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), one of the most authoritative measures of quality in the country. The study could have been improved by gathering specific data on a greater number of individual surgeries. Given this new data, hospitals should continue to focus on understanding the many sources of surgical site infections in an effort to reduce readmissions.

Click to read the study, published today in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Medicare Hospital Quality Chartbook 2012: Performance Report on Outcome Measures

In-Depth [quality improvement study]: Patients undergoing surgery from 346 ACS NSQIP hospitals between January 1, 2012 and December 31, 2012 were included in this study. A total of 498,875 operations were included, with 18,143 patients undergoing bariatric surgery, 35,112 colectomy or proctectomy, 33,895 ventral hernia repair, 25,119 hysterectomy, 38,671 hip or knee arthroplasty, and 6,341 lower extremity vascular bypass. SSI accounted for 19.5% of readmissions, while ileus or obstruction accounted for 10.3%. Approximately 3.3% of patients readmitted for SSI experienced an SSI during their hospitalization. Patients discharged to a location other than home (e.g., nursing facility) were also more likely to be readmitted (HR 1.40; 95%CI 1.35-1.46). The timing of surgical readmissions not associated with particular postoperative day.

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