S. A. Eidelson1, J. Parreco1, M. B. Mulder1, K. G. Proctor1, R. Rattan1 1University Of Miami,Department Of Surgery,Miami, FL, USA
Introduction:
The purpose of this study was to identify risk factors and costs associated with readmission after umbilical hernia repair (UHR) across the United States.
Methods:
The 2013-2014 Nationwide Readmissions Database was queried for patients admitted for UHR. Multivariate logistic regression identified risk factors for 30-day readmission at index and different hospitals. Readmission cost was calculated using cost-to-charge ratios.
Results:
Of the 105,608 patients admitted for UHR, 8.9% (n=9,372) were readmitted within 30 days. Of those, 15.6% (n=1,461) occurred at a different hospital. Of the 18.5% (n=19,569) patients readmitted within 1 year, 1.2% (n=225) were due to recurrence. Risk factors unique to readmission to a different hospital included: elective initial admission (OR 1.23, p=0.001), age 18-44 years (OR 1.83, p = 0.019), and age 45-64 years (OR 1.38, p=0.006). Protective factors unique to readmission to a different hospital included: bowel resection (OR 0.76, p<0.001), medium hospital size (OR 0.67, p<0.001), and large hospital size (OR 0.56, p<0.001). Other risk factors for readmission to a different hospital included: leaving against medical advice (AMA) (OR 5.32, p<0.001), discharge to a skilled nursing facility (SNF) (OR 2.44, p<0.001), discharge with home health care (OR 1.67, p<0.001), Medicare (OR 2.07, p<0.001), Medicaid (OR 1.48, p<0.001), Charlson Comorbidity Index ≥2 (OR 1.49, p<0.001), and length of stay (LOS) >7 days (OR 1.68, p<0.001). Risk factors for readmission to the index hospital included: bowel resection (OR1.28, p<0.001), leaving AMA (1.65, p=0.013), discharge to SNF (OR 1.41, p<0.001), discharge with home health care (OR 1.56, p<0.001), medium hospital size (OR 1.13, p=0.004), large hospital size (OR 1.18, p<0.001), Medicare (OR 1.49, p<0.001), Medicaid (OR 1.35, p<0.001), CCI ≥2 (OR 1.23, p<0.001), and LOS >7 days (OR 1.93, p<0.001). Risk factors for readmission overall included: bowel resection (OR 1.19, p<0.001), leaving AMA (OR 2.30, p<0.001), discharge to SNF (OR 1.56, p<0.001), initial hospitalization at a for-profit hospital (OR 1.11, p=0.022) or metropolitan teaching hospital (OR 1.26, p<0.001), public insurance (Medicare OR 1.58, p<0.001; Medicaid OR 1.37, p<0.001), CCI ≥2 (OR 1.27, p<0.001), and LOS >7 days (OR 1.92, p<0.001). Laparoscopic surgery was protective against readmission (OR 0.92, p=0.001). The median readmission cost was higher for patients readmitted to a different hospital ($9,817 [$5,560-19,113] vs $9,129 [$5,183-$16,776], p<0.001). The median cost of recurrence within 1 year was $12,299 [$6,298-$25,120].
Conclusion:
This is the first UHR readmission study using a nationally representative sample that includes readmissions to a different hospital. A significant proportion of readmission after UHR occur at a different hospital and are not captured by current benchmarking. Compared to readmission to the index hospital, risk factors are unique and costs are higher.