Readmission After Emergency General Surgery Far Too Common, Study Finds

Hospital readmission rates following surgery can lead to a decreased quality of patient care and increased medical costs; thus, it has long been a goal in the healthcare field to reduce these rates. A recent study published by JAMA Surgery intended to pinpoint risk factors for hospital readmission in patients who underwent an emergency general surgery (EGS) procedure, in hopes of finding out what decreases readmissions in the long run.

The study investigated patients older than 18 years of age who were undergoing EGS, as found in the California State Inpatient Database on January 15, 2015. Patient demographics, insurance type, Charlson Comorbidity Index score (taking into account co-existing illnesses), length of stay, complications, and discharge disposition were collected as predictors potentially associated with readmission. The strength of each of these associations was then determined using multivariate logistic regression. Hospital readmission within 30 days was recorded.

Out of the 177,511 patients included in the study, 5.91% was readmitted to the hospital within 30 days and 16.8% of those were readmitted at a different hospital than their original. The most common reasons for readmission were surgical site infections, gastrointestinal complications, and pulmonary complications.

From the demographic-based predictors, significantly higher readmission rates were seen in patients older than 65 years, who were black, and who had high Charlson Comorbidity Index scores. Significantly lower readmission rates were seen in patients who stayed in hospital less than 4 days, and in those who were discharged home. Gender had no effect in readmission likelihood.

Independent risk factors for readmission included having a Charlson Comorbidity Index score over 2, being discharged against medical advice, staying in hospital more than 7 days, and having public insurance.

Understanding and identifying these high-risk factors for hospital readmission provides an opportunity to reduce total readmission rates in the future.

“Reducing readmissions is a noble cost-saving goal with benefits not only to the hospitals, but also to the patients,” authors wrote. “However, it is critical to understand the underlying factors associated with readmission to appropriately identify measures that address the true problem.”

The study findings intimate that readmission after EGS procedures is far too common, and that identifying these specific risk factors and targeting patients who exhibit them is the step in the right direction in reducing readmissions. It also contributes further evidence “that we have a great opportunity to intervene on behalf of our patients and improve their outcomes,” said O. Joe Hines, MD, of the David Geffen School of Medicine at University of California, Los Angeles.