R. H. Hollis1,2, L. A. Graham1,2, J. S. Richman1,2, M. S. Morris1,2, M. T. Hawn3 1University Of Alabama At Birmingham,Dept. Of Surgery,Birmingham, AL, USA 2Birmingham VA Medical Center,Center For Surgical, Medical Acute Care Research And Transitions (C-SMART),Birmingham, AL, USA 3Stanford School Of Medicine,Dept. Of Surgery,Stanford, CA, USA
Introduction: Though postoperative surgery clinic visits are routinely performed, little is known about the relationship between surgery clinic visits and hospital readmissions. We hypothesized that timing of post-discharge surgery clinic visits is associated with readmission risk following gastrointestinal surgery.
Methods: Using VASQIP data we identified patients discharged following gastrointestinal surgery with at least a two-day postoperative length of stay in VA facilities between years 2008-2014. Our independent variable of interest was the occurrence of a postoperative general surgery clinic visit identified in the VA Corporate Data Warehouse (CDW). Our outcomes were 10-day and 30-day hospital readmission rates. To evaluate the association of clinic visit and hospital readmission, we used cox-proportional hazard models with general surgery clinic visit as a time-varying covariate and controlled for patient, procedure, and inpatient stay factors associated with readmission. To assess whether timing of clinic visits was associated with readmission, we performed a facility level analysis and tested the association between facility rate of readmission and mean time from discharge to initial clinic visit using Pearson correlation. Facilities performing less than twenty surgeries were excluded.
Results: Of 85,219 patients discharged after undergoing inpatient gastrointestinal surgery, hospital readmissions occurred in 6218 (7.3%) patients within 10-days and in 10,451 (12.3%) within-30-days. A general surgery visit was recorded in 28,933 (33.9%) patients within 10 days following discharge and in 59,279 (69.5%) within 30-days. Overall, the median time to readmission was 8 days (IQR: 4-16), and the median time to clinic visit was 11 days (IQR 7-15). Only 2,810 (26.9%) of patients readmitted within 30-days had a preceding general surgery clinic visit. Having a postoperative general surgery clinic visit was associated with a significantly decreased hazard of readmission within 10 days (HR 0.64, 95%CI 0.59-0.70) and 30-days (HR 0.63, 95%CI 0.60-0.66) of discharge. In examination of 114 facilities, longer mean time to initial postoperative clinic visit was associated with a higher facility rate of 10-day (r=0.24, p=0.01) and 30-day readmission (r=0.30, p<0.01).
Conclusion: Following discharge from inpatient gastrointestinal surgery, postoperative general surgery clinic visits were associated with decreased hazard of 10-day and 30-day hospital readmissions. Facilities with longer time to postoperative clinic visits were associated with higher readmission rates. These findings highlight early postoperative surgical clinic visits as a potential important focus for reducing readmission rates.