I. R. Rossi1, S. W. Ross1, A. K. May1, C. E. Reinke1 1Carolinas Medical Center,Surgery,Charlotte, NC, USA
Introduction: The optimal timing of post-discharge follow-up to potentially impact readmission rates for emergency general surgery (EGS) procedures is unknown. A better understanding of time from discharge to unplanned readmission for EGS procedures may inform the optimal timing of post-discharge follow-up as well as additional interventions that may reduce unnecessary utilization of healthcare resources. We aimed to determine the timing of unplanned readmission for the most common EGS procedures. We hypothesized that certain EGS diagnoses are at increased risk for unplanned readmission and may present earlier than the traditional follow-up intervals.
Methods: The 2012-2015 National Surgical Quality Improvement Program (NSQIP) Participant User Data File (PUF) was analyzed to identify non-elective general surgery patients with an American Association for the Surgery of Trauma (AAST) defined EGS ICD-9 diagnoses. Cardiothoracic and vascular procedures were omitted. The top 5 most common CPT codes by AAST category were identified. Time from discharge to unplanned readmission was analyzed by diagnosis grouping and the most common readmission ICD-9 codes described. Readmission ICD-9 diagnoses were grouped into gastrointestinal, infectious, bleeding and other categories.
Results: Of the 597,208 non-elective general surgery patients identified, 310,073 had an AAST EGS diagnoses. The overall unplanned readmission rate was 7.54% for non-elective EGS procedures. The top 5 procedures in each category identified 30 unique CPT codes and accounted for 84% of all EGS readmissions. Colorectal procedures had the highest unplanned readmission rate at 11% with a median of 7 days to presentation after principal procedure. Notably, the median days to readmission were ≤ 10 days for all AAST EGS categories. 25.4% of all EGS readmissions at fewer than 2 weeks from index procedure are for gastrointestinal symptoms including obstruction, ileus, nausea/vomiting and other abdominal symptoms. Dehydration is the leading non-gastrointestinal cause for readmission at 3.25% of all EGS readmissions < 2 weeks from procedure.
Conclusion: Timing from principal operative procedure to any readmission varies by EGS diagnosis category and most importantly patients are readmitted far sooner than the traditional 2 week follow-up period. Follow-up at shorter intervals may facilitate more immediate intervention in order to avoid readmission and unnecessary hospital utilization.
