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Association Between Occurrence of a Postoperative Complication and Readmission: Implications for Quality Improvement and Cost Savings

Lawson, Elise H. MD, MSHS*,‡,§; Hall, Bruce Lee MD, PhD, MBA‡,¶; Louie, Rachel MS; Ettner, Susan L. PhD; Zingmond, David S. MD, PhD; Han, Lein PhD; Rapp, Michael MD, JD‖,**; Ko, Clifford Y. MD, MS, MSHS*,‡,§

doi: 10.1097/SLA.0b013e31828e3ac3
Feature

Objective: To estimate the effect of preventing postoperative complications on readmission rates and costs.

Background: Policymakers are targeting readmission for quality improvement and cost savings. Little is known regarding mutable factors associated with postoperative readmissions.

Methods: Patient records (2005–2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Risk factors, procedure, and 30-day postoperative complications were determined from ACS-NSQIP. The 30-day postoperative readmission and costs were determined from Medicare. Occurrence of a postoperative complication included surgical site infections and cardiac, pulmonary, neurologic, and renal complications. Multivariate regression models predicted the effect of reducing complication rates on risk-adjusted readmission rates and costs by procedure.

Results: The 30-day postoperative readmission rate was 12.8%. Complication rates for readmitted and nonreadmitted patients were 53% and 16% (P < 0.001). Patients with a postoperative complication had higher predicted probability of readmission and cost of readmission than patients without a complication. For the 20 procedures accounting for the greatest number of readmissions, reducing ACS-NSQIP complication rates by a relative 5% could result in prevention of 2092 readmissions per year and a savings to Medicare of $31.0 million per year. Preventing all ACS-NSQIP complications for these procedures could result in prevention of 41,846 readmissions per year and a savings of $620.3 million per year.

Conclusions: This study provides substantial evidence that efforts to reduce postoperative readmissions should begin by focusing on postoperative complications that can be reliably and validly measured. Such an approach will not eliminate all postoperative readmissions but will likely have a major effect on readmission rates.

Policymakers are targeting readmission for quality improvement and cost savings. This study provides substantial evidence that efforts to reduce postoperative readmissions should begin by focusing on postoperative complications that can be reliably and validly measured. Such an approach will not eliminate all postoperative readmissions but will likely have a major effect on readmission rates.

*Departments of Surgery

Medicine, David Geffen School of Medicine, University of California, Los Angeles

Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

§VA Greater Los Angeles Healthcare System, Los Angeles, Ca

Department of Surgery, School of Medicine, Washington University in St Louis and Barnes Jewish Hospital; Center for Health Policy and the Olin Business School at Washington University in St Louis; and Department of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, MO

Centers for Medicare and Medicaid Services (CMS), Baltimore, MD

**Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.

Reprints: Elise H. Lawson, MD, MSHS, David Geffen School of Medicine at University of California at Los Angeles, Department of Surgery, 10833 Le Conte Avenue, 72-215 CHS, Los Angeles, CA 90095. E-mail: elawson@mednet.ucla.edu.

Disclosure: E.H.L.'s time was supported by the VA Health Services Research and Development program (RWJ 65-020) and the American College of Surgeons through the Robert Wood Johnson Foundation Clinical Scholars Program. This study was partially funded by a contract from the CMS. For the remaining authors, none were declared. The views expressed in this article represent the authors’ views and do not necessarily represent official policy or opinions of the Department of Health and Human Services, the CMS. The authors declare no conflicts of interest.

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© 2013 by Lippincott Williams & Wilkins.