R. F. Shah1, E. Pavey1, A. Dahlke1, M. Ju1, R. Merkow1, A. Yang1, R. Rajaram1, K. Bilimoria1 1Surgical Outcomes And Quality Improvement Center (SOQIC),Department Of Surgery, Feinberg School Of Medicine, Northwestern University,Chicago, IL, USA
Introduction: Readmissions have become a major focus of pay-for-performance programs in the past 5 years. Investigating the reasons for readmissions is necessary in order to help hospitals identify targets for improvement. Surgical site infections (SSI) have been found to be the main contributing factor to readmissions. Hospitals may differ in how they manage post-discharge SSIs (e.g. if they manage patients in an outpatient clinic), and thus readmissions for SSI may be a useful hospital-level quality indicator. Our objectives were to (1) investigate the variation that exists between hospitals with their rates of readmissions for SSI and (2) assess patient- and hospital level factors associated with readmissions.
Methods: Patients undergoing a colectomy at hospitals enrolled in the American College of Surgeons National Surgical Quality Improvement Program throughout January 1, 2012, and December 31, 2013 were included in the study population. Readmission rates and indications for those readmissions were assessed. Proportional hazards models were developed to examine risk-adjusted hospital variation and the association of patient and hospital factors with readmissions for SSI. We then ranked the hospitals in our study by their odds ratios, and calculated the correlation of this rank with overall hospital risk-adjusted SSI rates as well as overall hospital risk-adjusted readmission rates
Results: Based on 30,876 patients from 145 hospitals, the rate of readmissions for SSI was 1.07%. Hospital risk-adjusted odds ratios for readmissions for SSIs varied from 0.40 to 2.80. 4 hospitals performed significantly better than expected (2.8%), and 5 hospitals performed significantly worse than expected (3.5%). Hospital performance regarding readmissions for SSI was not correlated with overall hospital risk-adjusted SSI rates or readmission rates (r=.30 and r=.026, respectively). Risk factors for readmissions for SSIs include class III obesity (HR, 1.95; CI, 1.3 – 2.93; P < .01), ASA class III (HR, 1.79, CI, 1.32-2.3, P<.001), smoking status (HR 1.32; CI, 1.01 – 1.71, P = .04), current steroid use (HR 1.58; CI, 1.09 – 2.28, P = .02), operative times over 100 minutes (P < .001), and open surgery (P<.01). There was a non-significant trend for larger hospitals to have higher readmission for SSI rates (P=.18). A resident-to-bed ratio under 0.3 was also a risk factor for readmission for SSI (P<.01) compared to higher ratios.
Conclusions: Readmission for SSI rates represents a unique aspect of quality beyond that offered by just SSI and overall readmission rates alone. The rate of unplanned readmissions for SSI is a novel quality indicator that may provide actionable quality improvement information for hospitals.
