Prediction of hospital readmission of surgical patients
Readmission to hospital following discharge from hospital after elective surgery is a widely accepted surgical performance indicator. However, there is no published evidence on risk factors leading to readmissions or how to minimize the risk of readmissions. Surgeons worldwide feel that readmissions are more frequent after complex surgery and after surgery on elderly and frail patients. Strategies to avoid readmissions include hospitalising the patient longer, but no study has shown its effectiveness.
This US American study from Kentucky enrolled 266 patients prospectively. All patients had a major abdominal procedure at a Surgical Oncology division within a 12 months period. Most procedures were open operations (76%) upper GI procedures for a malignancy. Variables examined included patient factors (medical co-morbidities, surgical history, etc), social factors, perioperative factors (wound care, oral intake capacity, etc), and factors on discharge location (home, home with care or rehab).
All patients were followed for 90 days. Readmissions to hospitals were the primary study endpoint. Visits to the Emergency Department without the need for readmissions did not count as an event.
Patients’ median age was 62 years. Past medical history that was most common was the presence of diabetes, prior history of coronary artery disease and a smaller percentage that had a prior history of COPD. The median number of medications patients were on preoperatively was 6. The overall median stay was 6 days.
Predictors of readmission include advanced age and the development of surgical complications. Low oral intake at discharge and a higher number of medications, patients require at discharge was highly predictive of readmission. Lack of appropriate support at home was another key factor that leads to increased rates of readmission. Home care agencies were a risk factor for readmission to hospital. Dehydration was the most common reason for readmission.
While normally patients are seen at 6 weeks post surgery, the authors suggested that an earlier outpatient visit might identify problems and could reduce readmissions to hospital.
For more information:
Readmission Rates After Abdominal Surgery: The Role of Surgeon, Primary Caregiver, Home Health, and Subacute Rehab. Annals of Surgery, 2011; 254(4): 591-597.