L. N. Clark1, M. C. Helm1, S. Singh1, J. C. Gould1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: Readmission rates are an important surgical quality metric. Readmissions up to 30 days after discharge following a procedure are the most commonly examined metric. We hypothesize that ‘very early’ readmissions (0-3 days after discharge) have a significantly different root cause than ‘early’ readmissions (4-30 days after discharge).
Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) datasets from 2014-2015 were used to identify patients undergoing a general or vascular surgery procedure. Patients were excluded if they died during the index admission, were discharged greater than 30 days from the operation, or did not have readmission data entered. Patient demographics, medical comorbidities present at the time of surgery, and data regarding postoperative morbidity were analyzed. Complications were graded according to the Clavien-Dindo classification. Binary logistic regression was used to compare age, functional status, comorbidities, discharge destination and complications to determine their relationship to any 30-day readmission as well as readmission within 3 days compared to 4-30 days following discharge.
Results: A total of 850,043 patients met inclusion criteria: 55.5% female, average age 55 years (range 18-89). Of these patients, 55,212 (6.5%) were readmitted within 30 days and 13,570 (1.6%) were readmitted within three days of discharge. These very early readmissions comprised 24.6% of all readmissions (Figure 1). When evaluating all readmissions from 0-30 days regardless of timing, age ≥ 65 (Odds Ratio [OR] 1.5; 95% Confidence Interval [CI]; 1.5-1.6, p<0.0001), ≥3 comorbidities (OR 2.7; 95% CI; 2.7-2.8, p<0.0001), preoperative functional dependent status (OR 3.1; 95% CI; 2.8-3.3, p<0.0001), discharge to facility other than home (OR 2.8; 95% CI; 2.7-2.9, p<0.0001), any grade three or four complication prior to discharge (OR 2.4; 95% CI; 2.4-2.5, p<0.0001), and any grade three or four complication after discharge (OR 84.7; 95% CI; 81.3-88.1, p<0.0001) were all identified as risk factors. The only factor found to be significantly associated with very early readmission compared to early readmission was any grade three or four complication prior to discharge (OR 1.3; 95% CI; 1.2-1.4, p<0.0001).
Conclusion: Readmissions within 3 days of surgery constitute a large portion of all 30-day readmissions. Grade 3 and 4 complications prior to initial discharge are significantly associated with an increased risk of readmission, especially within the first 3 days. Further research is needed determine if effective and targeted strategies can be developed to prevent very early readmission.
