R. Bhagat1, E. Juarez-Colunga2, N. O. Glebova1, W. G. Henderson2, D. Fullerton1, M. J. Weyant1, J. D. Mitchell1, R. McIntyre1, R. A. Meguid1 2University Of Colorado Denver,Department Of Biostatistics & Informatics,Aurora, CO, USA 1University Of Colorado Denver,Department Of Surgery,Aurora, CO, USA
Introduction: Hospital readmissions are viewed as a marker of inferior healthcare quality & penalized with decreased reimbursement. Characteristics of unplanned readmissions after hiatal & paraesophageal hernia repairs (HPHR) are not well understood. We sought to determine the association of complications to postoperative unplanned readmission to identify opportunities for intervention.
Methods: We analyzed the ACS NSQIP database (2012-14) to characterize 30-day postoperative related, unplanned readmissions after HPHR identified by CPT code. Timing of, reason for & association between postoperative complication & unplanned readmission was analyzed.
Results: Of 23,257 patients who underwent HPHR, 17,194 (74%) were female, mean age was 55.3 years & mean length of stay (LOS) was 2.4 days. 1,281 (6%) experienced >=1 complication; death occurred in 45 (0.2%) patients. 963 (4.1%) experienced a related, unplanned readmission within 30 days of surgery. Patients who were readmitted were older (mean age 56.4 vs 55.2 years, p=0.02), had a longer mean LOS (3.2 vs 2.3 days, p<0.001), had more complex operations (mean work relative value unit with standard deviation: 20.8 (10.3) vs 18.7 (11.0), p<0.001) & more emergency operations (3.3% vs 1.9%, p=0.001). Among patients who developed >=1 postoperative complications, 55% (706/1,281) had complications while an inpatient & 8% (57/706) readmitted, 41% (532/1,281) were identified after discharge & 54% (285/532) readmitted, & 0.2% (39/1,281) had complications both as an inpatient & after discharge & 74% (29/39) readmitted. Of patients who experienced an unplanned readmission, 39% (371/963) had a documented postoperative complication, with 77% (285/371) developing their complication after discharge. Complications at readmission were mainly gastrointestinal (GI) (42%; 390/937), infectious (13%; 124/937), pulmonary (10%; 98/937) & pain (10%; 97/937). 53% of related, unplanned readmissions occurred within 7 days of discharge, & 79% within 14 days (Figure 1).
Conclusion: Related, unplanned readmission within 30 days of surgery occurred in 4% of patients undergoing HPHR. Over half of patients who developed a complication after discharge were readmitted. Patients who experienced related, unplanned readmissions underwent more complex operations & were older than those not readmitted. The most common reason for readmission was GI complication. Over half of readmissions occurred within 1 week of discharge, & nearly 80% within 2 weeks. Follow-up within the first few days after discharge from surgery may help identify patients suffering post-discharge complications & who are at risk of unplanned readmission. This may facilitate outpatient intervention targeted at common complications to prevent unplanned readmission.
