Postoperative Complications Leading Cause of Hospital Readmissions

Postoperative complications are the most significant independent risk factor leading to 30-day hospital readmissions among general surgery patients, according to a new study.

Researchers at Emory University School of Medicine (Atlanta, GA, USA) conducted a study involving 1,442 patients to identify factors associated with 30-day readmission after general surgery procedures. Preoperative, intraoperative, and postoperative outcomes were collected on the patients, and were merged to clinical data to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for the patients who were readmitted.

The results showed that 163 patients (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal problem/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound. Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection.

Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. The most significant independent risk factor for readmission was the occurrence of any postoperative complication. The study was published in the September 2012 issue of the Journal of the American College of Surgeons.

“A patient who has one complication is more likely to be readmitted than a patient with no complications,” said senior study author John Sweeney, MD, chief of the division of general and gastrointestinal surgery. “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.”

“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,” added Dr. Sweeney. “Decreasing complications will benefit the patient, the hospital, and the payer, and will improve quality of care. It will decrease length-of-stay and decrease hospital readmissions.”

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Emory University School of Medicine