J. Chen1, C. Bautista1, D. Eddington2, J. Agarwal1, A. Kwok1 1University Of Utah, Department Of Surgery, Division Of Plastic And Reconstructive Surgery, Salt Lake City, UT, USA 2University Of Utah, Department Of Internal Medicine, Division Of Epidemiology, Salt Lake City, UT, USA
Introduction:
Currently, research databases and insurance policies utilize a 30-day postoperative period to assess for surgical complications. A literature search revealed that Coronary Artery Bypass Grafting (CABG), colectomy, total hip replacement (THR), lower extremity amputation (LEA), and autologous breast reconstruction (ABR) have high readmission rates spanning beyond 30 days. These findings raise concerns that we are underestimating the window for postoperative complications. We aim to assess the timing of unplanned readmissions of the aforementioned procedures utilizing the Nationwide Readmissions Database (NRD), which uniquely captures inpatient readmissions beyond the initial 30 days following an index procedure.
Methods:
The 2018 NRD was queried to identify adult patients (≥18 years) who underwent CABG, colectomy, LEA, THR, and ABR procedures. Unplanned readmissions were defined as postoperative wound-related complications, with or without a reoperation. Patients and readmissions were identified using ICD-10 codes. Time from index admission day to the first readmission was categorized into early readmissions (0-30 days), and late readmissions (31-90 days and >90 days). Our analysis utilized predetermined NRD discharge weighting, ensuring that our results were nationally representative in terms of baseline patient characteristics.
Results:
The weighted sample from the NRD included 1,499,369 patients. During the examined calendar year, 2.3% (n = 35195) of the total patient population experienced an unplanned readmission related to wound complications. 1.7% (n = 25703) of all patients experienced a wound-related complication as their first readmission; of which, 74.5% (n = 19160) were readmitted between 1-30 days, and 19.1% (n = 4909) were readmitted between 30-90 days from discharge. The remaining 6.4% (n = 1634) were readmitted at > 90 days. Individual procedure rates of wound-related first readmissions between 1-30 days and >30 days, respectively, are as follows: CABG (71.4%, 28.6%), Colectomy (78.5%, 21.5%), LEA (59.6%, 40.4%), THR (72.2%, 27.8%) and ABR (71.3%, 28.7%). Per surgery, 90% of wound-related readmissions occurred on or before 58 days for CABGs, 68 days for Colectomies, 85 days for LEAs, 59 days for THRs, and 72 days for ABRs. Notably, 90% of all wound-related readmissions for all five procedures occurred on or before 65 days, or 9.3 weeks, from the index admission.
Conclusion:
Our examination of multiple procedures and their associated rates of postoperative readmissions demonstrate that a clinically significant portion of complications will occur after the standard 30-day period. We demonstrate that a period of approximately 9 weeks would serve as a better metric for postoperative complications, specifically those which result in readmissions. As a result of this study, future aims are to establish procedure-specific postoperative monitoring periods for complications and readmissions in policies and research.