Study: Underlying Reasons Associated with Hospital Readmission Following Surgery in USA

July 8, 2015
admission record
Originally published in JAMA February 2015

Financial penalties for readmission have been expanded beyond medical conditions to include surgical procedures. Hospitals are working to reduce readmissions; however, little is known about the reasons for surgical readmission.

The most common reason for unplanned readmission was surgical site infection (SSI) overall (19.5%) and also after colectomy or proctectomy (25.8%), ventral hernia repair (26.5%), hysterectomy (28.8%), arthroplasty (18.8%), and lower extremity vascular bypass (36.4%). It is worth noting that only 3.3% of patients readmitted for SSIs had experienced an SSI during their index hospitalization.

“These results clearly demonstrates that the vast majority of complications that cause readmissions are not due to a lack of coordination or complications that occurred during the initial hospitalizations,” says Bilimoria. “These complications were new and occurred after the patients were discharged and were recovering at home.”

The study also found that the most common cause for unplanned readmissions was surgical-site infections at 19.5 percent, followed by delayed return of bowel function with an overall rate of 10.3 percent. The study’s authors go on to point out that while these two postsurgical complications are the top two causes for readmissions, compliance with available quality measures to reduce these complications is often already high among hospitals in America and implementing, “policies requiring reductions in readmissions without understanding how to impact improvement could be counterproductive.”

“Many of the issues that were identified can help hospitals better focus their efforts to continue to reduce potential readmissions. Our results also highlighted that many of the complications involved in readmissions, such as surgical-site infections, are already well-know and part of other CMS pay-for-performance programs, which means hospitals are effectively being penalized twice for the same complications,” adds Bilimoria.

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