A recent study, published in the September issue of the Journal of the American College of Surgeons reveals that complications in the 30 day post-surgery window are generally the main reason patients are readmitted to hospitals.

Senior author of the study, John F. Sweeney, MD, FACS, chief, division of general and gastrointestinal surgery at Emory University School of Medicine in Atlanta and also the director of the department of surgery’s clinical quality and patient safety program said:

“Hospital readmissions are the tip of the iceberg, but when you dig deeper, it is the postoperative complications that drive readmissions among general surgical patients. Better understanding that predictors of readmission for general surgery patients will allow hospitals to develop programs to decrease readmission rates.”

For their study, the researchers looked at hospital records from patients who were involved in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a program designed to improve the quality of care in private sector hospitals.

Emory University Hospital data was added to data from ACS NSQIP data in order to discover why readmissions occur when they are not planned.

The records of 1,442 general surgery patients who had operations between 2009 and 2011 were analyzed by the authors. Within 30 days of being discharged from the hospital, 163 of these individuals were readmitted.

After seeing these numbers, the researchers looked into what factors could have caused the patients to be readmitted. The factors contributing to the readmissions included; what kind of procedure was done on the patient, if there were any complications after surgery, ICD-9 coding data, and patient demographics.

Dr. Sweeny continued: “Surgical patients are different from medical patients because the surgical procedure, in and of itself, places them at risk for readmission to the hospital, above and beyond the medical problems.”

The reason for the analyzation of readmission rates, according to the researchers, is due to regulation changes issued by the Centers for Medicare & Medicaid Services (CMS), which makes hospitals responsible for any readmissions for medical diseases in the following 30 day period. In the future, they plan to use this method for surgical patients as well.

When the researchers looked into factors contributing to hospital readmissions, they determined that certain surgical procedures and how many complications the patients experienced after their operation were main reasons that they were readmitted.

Sweeney said: “Complex gastrointestinal procedures carry a higher risk of hospital readmission. Pancreatectomy, colectomy, and liver resection have a higher complication rate because of the surgical complexity.”

According to the ICD-9 coding data, two main reasons for hospital readmission, accounting for almost half of all readmissions are gastrointestinal complications at 27.6% and surgical infections at a rate of 22.1%.

The authors determined that the more complications a patient has after surgery, the higher their risk of having to go back to the hospital.

Dr. Sweeney continued:

“A patient who has one complication is more likely to be readmitted than a patient with no complications. The more complications a patient experiences, the more likely the readmission. In the hospital, a patient who experiences a complication has a lower risk of readmission compared with a patient who develops a complication after going home.”

Individuals with one or more complication after surgery were reported to have a 4% more likely chance of going back to the hospital, in comparison with patients who experienced no complications at all. If the patients had two complications post-surgery, they had the highest chance of being readmitted.

Hospital length stays differed due to complications as well:

  • Patients with no complications – 4 days
  • Patients with 1 complication – 9 days
  • Patients with 3 or more complications – 24 days

In addition, patients who experienced urinary tract infections or sepsis after surgery had a 5% higher chance of being readmitted to the hospital than people who had no complications. Wound infection and pulmonary complications after operations resulted in a 3.5% higher risk of being readmitted.

“The leading surgical complications are would infections, pulmonary complications, and urinary tract infections. UTIs were the worst complication we found, although they don’t happen frequently, but they are associated with the highest risk of readmission.”, said Dr. Sweeney.

According to Dr. Sweeney, a large financial benefit for hospitals, patients and payers would come from reducing postoperative complications. Dr. Sweeney concluded:

“The biggest bang for the buck is going to be a combination of decrease of complications. and decrease of length-of-stay, resulting in decrease of readmissions. Decreasing complications will benefit the patient, the hospital, and the payer, and will improve quality of care. It will decrease the length-of-stay and decrease hospital readmissions.”

Written by Christine Kearney