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Readmission Rates After Abdominal Surgery: The Role of Surgeon, Primary Caregiver, Home Health, and Subacute Rehab

Martin, Robert C. G. MD, PhD; Brown, Russell MD; Puffer, Lisa NP; Block, Stacey NP; Callender, Glenda MD; Quillo, Amy MD; Scoggins, Charles R. MD, MBA; McMasters, Kelly M. MD, PhD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182300a38
Papers of the 131st ASA Annual Meeting
Abstract

Objective: To prospectively evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures.

Background: Recommendations from MedPAC that the Centers for Medicare and Medicaid Services (CMS) report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians.

Methods: Analysis of 266 prospective treated patients undergoing major abdominal surgical procedures from September 2009 to September 2010. All patients were prospectively evaluated for underlying comorbidities, number of preop meds, surgical procedure, incision type, complications, presence or absence of primary and/or secondary caregiver, their education level, discharge number of medications, and discharge location. Univariate and multivariate analyses were performed.

Results: Two hundred twenty-six patients were reviewed with 48 (18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58 (22%) pancreas, and 33 (12%) other. Seventy-eight (30%) were readmitted for various diagnoses the most common being dehydration (26%). Certain preoperative and intraoperative factors were not found to be significant for readmission being, comorbidities, diagnosis, number of preoperative medications, patient education level, type of operation, blood loss, and complications. Significant predictive factors for readmission were age (≥69 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake (52% vs. 23%), and DC home with a home health agency (62% vs. 11%)

Conclusion: Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon's performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.

In Brief

The aim of this study was to evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures. Readmission rates for surgeons will become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon's performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.

Author Information

Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY.

Reprints: Robert Martin, MD, PhD, FACS, Division of Surgical Oncology, University of Louisville, 315 E. Broadway - #312, Louisville, KY 40202.

Disclosure: The authors declare that they have nothing to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.