B. S. Brooke1, P. P. Goodney3,4, L. W. Kraiss1, D. J. Gottlieb4, S. R. Finlayson1 1University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 3Dartmouth-Hitchcock Medical Center,Department Of Surgery,Lebanon, NH, USA 4The Dartmouth Institute For Health Policy & Clinical Practice,Lebanon, NH, USA
Introduction: Readmissions are common following major surgery, however, it is unknown whether the readmission destination (either the index hospital where surgery was performed, or a different hospital) affects mortality risk in the period following surgery. The objective of this study was to determine if patients acheive better outcomes if they are readmitted to the index hospital where their major surgical procedure was performed.
Methods: We performed a retrospective cohort study among Medicare patients who required hospital readmission within 30-days following 12 major surgical procedures (open abdominal aortic aneurysm repair, infra-inguinal arterial bypass, aorto-bifemoral bypass, coronary artery bypass surgery, esophagectomy, colectomy, pancreatectomy, cholecystectomy, ventral hernia repair, craniotomy, hip replacement, and knee replacement) at nationwide acute-care and critical access hospitals between 2001 and 2011. Readmission destination was categorized as to the index hospital (including readmission to a different hospital and transfer back to the index hospital within 24 hours) or readmissions to a non-index hospital. We used generalized estimating equations with inverse probability weighting to determine associations between readmission destination and risk of 90-day mortality among patients requiring readmission following major surgical procedures.
Results: The proportion of patients readmitted or transferred to the index hospital where their operation occurred varied from 66% to 83% following all major surgeries, and was more likely to occur if the readmission was for a surgical versus a medical complication (P<.001). When compared to patients readmitted to non-index hospitals, risk-adjusted 90-day mortality was significantly lower for patients who returned to the index hospital where their surgical procedure was performed. This effect was significant (p<.001) for all procedures (figure), and was largest for patients readmitted after pancreatectomy (OR 0.58; 95% CI:0.47-0.68) and aorto-bifemoral bypass (OR 0.69: 95% CI:0.61-0.77). The mortality benefits associated returning to the index hospital was evident for both medical and surgical readmissions.
Conclusion: Patients readmitted following a wide range of major operations consistently achieve improved survival if they return to the hospital where their index operation took place. These findings may have important implications for value-based regionalization of surgical care.
