M. Morris1,3, L. Graham1,3, J. Richman1,3, R. Hollis1,3, C. Jones1,3, M. Hawn2 1University Of Alabama,Surgery,Birmingham, Alabama, USA 2Stanford University,Surgery,Palo Alto, CA, USA 3Birmingham Veterans Affairs Hospital,Surgery,Birmingham, AL, USA
Introduction:
Post-operative hospital readmission rates are now publically reported and targeted for quality improvement measures. Identifying which readmissions are preventable or unavoidable is challenging. The ability to predict readmission rates at the time of discharge would potentially change clinical practice. We hypothesize that patients experiencing a pre-discharge complication would have increased rates of readmission.
Methods:
We examined all gastrointestinal surgery cases at 120 VA facilities from 2008-2014 with a total hospital length of stay of at least 2 days. Our independent variable of interest was the occurrence of any pre-discharge complication as assessed by the VA Surgical Quality Improvement Program. Our outcome of interest was inpatient readmission within 30 days following hospital discharge. Chi-square tests statistics and t-tests were used to examine differences in bivariate statistics and a multivariate logistic model was used to model 30-day readmission in the population.
Results:
Our sample includes 86,820 procedures among 77,451 patients at 120 VA facilities with an overall readmission rate of (12.3%). In our cohort, 7,927 patients (9.1%) experienced a pre-discharge complication. Superficial wound infection was the most common pre-discharge complication (2.1%), followed by urinary tract infection (1.2%) and reintubation (1.2%). Readmission rates were significantly higher in patients experiencing a pre-discharge complication when compared to those not experiencing an in-hospital complication (17.5% vs 11.8%, p<0.01). Patients who experienced a pre-discharge complication had a longer mean length of post-operative hospital stay (13.5 days) as compared to those without a pre-discharge complication (5.7 days, p<0.01), but were no more likely to experience a post-discharge complication (7.1% vs. 6.6%, p=0.07). In the final adjusted model, pre-discharge complications were only associated with readmission when postoperative hospital stay was less than 7 days (OR=1.4, 95%CI=1.2-1.7), however only 11.5% of patients experiencing an in-hospital complication had a post-operative stay of less than 7 days.
Conclusion:
Occurrence of pre-discharge complications in patients with postoperative length of stay greater than seven days was not associated with readmission suggesting that sequelae of the complication resolve during the prolonged index hospitalization for the majority of admissions.