A. Ejaz1, A. A. Gonzalez1, F. Gani2, T. M. Pawlik2 1University Of Illinois At Chicago,Surgery,Chicago, IL, USA 2Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction:
Reducing postoperative readmissions have been identified as an opportunity for healthcare cost containment. We sought to identify the impact of index admission costs on readmission rates and quantify any potential variation in costs and readmission attributable to the patient, procedure, and provider.
Methods:
Patients who underwent a colorectal, pancreas, or liver resection between 2009 and 2013 were identified at a tertiary care hospital. Variations in the index hospital costs among providers were compared using coefficient of variation (CV).
Results:
Among 4,114 patients, the overall unadjusted 30-day readmission rate was 17.2% varying by procedure (colorectal: 18.6% vs. pancreas: 18.6% vs. liver: 10.1%, P<0.001). The mean cost of surgery during the index hospitalization was $33,809±34,663 and varied by procedure (colorectal: $32,957 vs. pancreas: $37,360 vs. liver: $27,476, P<0.001). Median index length of stay (LOS) was 7 days (IQR: 5, 11) and was higher among patients who were eventually readmitted (readmitted: 8 days [IQR 6, 13] vs. not readmitted: 7 days [IQR 5, 11], P<0.001). Patients readmitted had a higher incidence of index hospitalization perioperative morbidity (readmitted: 20.3% vs. not readmitted: 16.4%; P=0.007). On adjusted analysis, pancreas (OR 1.88) or colorectal (OR 1.94) resection and an observed: expected index LOS >1 (OR 1.44) were independently associated with a higher risk of readmission (all P<0.001). Total index hospitalization costs were higher among patients who were readmitted (readmitted: $36,607±26,718 vs. not readmitted: $33,229±36,069; P<0.001). Further, among patients without an index hospitalization complication, total costs remained higher among patients who were eventually readmitted (readmitted: $31,138±19,528 vs. not readmitted: $25,964±13,999; P<0.001). At the provider level, readmission rates varied among surgeons performing the same procedure (colorectal: 0%-33.3% vs. pancreas: 0%-37.5%vs. liver: 0%-25%). Similarly, substantial variation in index hospitalization costs was also observed among surgeons performing the same procedure for readmitted (Colorectal: 87.6% vs. Pancreas: 72.7% vs. Liver: 58.6%) and non-readmitted (Colorectal: 120.7%% vs. Pancreas: 103.4% vs. Liver: 69.9%) patients.
Conclusion:
30-day readmission rates among patients undergoing major abdominal surgery vary significantly. Higher index hospitalization costs did not translate in to lower readmission rate.