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Surgical site infection and ileus were the most frequent reason for hospital readmission within 30 days, according to an analysis of data from the National Surgical Quality Improvement Program.
The findings, published online in the Feb. 3 JAMA, suggest that policies that penalize hospitals for readmissions may be ineffective and potentially counterproductive.
Dr. Karl Y. Bilimoria of Northwestern University, Chicago, and his colleagues examined patient data from 346 hospitals participating in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) between January 2012 and December 2012. Readmission rates and reasons were assessed for all surgical procedures and for six representative operations: bariatric surgery, colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass (JAMA 2015;313;483-95 [doi:10.1001/jama.2014.18614]).
Of the 498, 875 patient sample, the overall readmission rate was 5.7%. For individual procedures, the readmission rate ranged from 3.8% for hysterectomy to 14.9% for lower extremity vascular bypass.
The most common reason for readmission was surgical site infection (SSI; 19.5%), ranging from 11.4% after bariatric surgery to 36.4% after lower extremity vascular bypass. Ileus was the most common reason for readmission after bariatric surgery (24.5%) and the second most common reason overall (10.3%). Other common causes for readmission included dehydration or nutritional deficiency, bleeding or anemia, venous thromboembolism, and prosthesis or graft issues (after arthroplasty and lower extremity vascular bypass procedures). Only 2% of patients were readmitted for the same complication they had experienced during their index hospitalization. Just 3% of patients readmitted for SSIs had experienced an SSI during their index hospitalization.
The results show readmissions after surgery may not be an appropriate measure for pay-for-performance and cost-containment programs, such as the Centers for Medicare & Medicaid Service’s Hospital Readmissions Reduction Program, Dr. Bilimoria said. Performance targets without accepted courses of intervention might be more prone to unintended or ineffective behaviors and consequences, he noted.
“Surgical readmissions mostly reflect postdischarge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI,” he said. “Efforts should focus on reducing complication rates overall than simply those that occur after discharge, and this will subsequently reduce readmission rates as well.”
On Twitter @legal_med
These findings provide an unprecedented opportunity to apply these lessons and make substantial reductions in surgical complications, Dr. Lucian L. Leape said in an editorial accompanying the study.
Changing systems is hard work and requires serious commitment. Changing hospital systems is especially difficult because of long-standing traditions and entrenched practices. Successful change requires leadership by those with the will, the determination, and the perseverance to overcome obstacles and motivate colleagues. It requires commitment, which comes from a sense of urgency and a sense of possibility.
One way to develop a sense of urgency is to translate rates into numbers – i.e., actual patients. For example, in this study, surgical site infections accounted for 19.5% of the unplanned readmissions. Even though this only represents 1% of the 498,875 ACS NSQIP patients undergoing surgery in 2012, that 1% equals 5,565 patients. Reducing that number by half would reduce pain and suffering for more than 2,700 patients. If similar success were achieved nationwide, the total would be many times that.
Dr. Lucian L. Leape is with the department of health policy and management at Harvard School of Public Health, Boston, and made these comments in an accompanying editorial (doi:10.1001/jama.2014.18666). He reported having no relevant financial disclosures.
These findings provide an unprecedented opportunity to apply these lessons and make substantial reductions in surgical complications, Dr. Lucian L. Leape said in an editorial accompanying the study.
Changing systems is hard work and requires serious commitment. Changing hospital systems is especially difficult because of long-standing traditions and entrenched practices. Successful change requires leadership by those with the will, the determination, and the perseverance to overcome obstacles and motivate colleagues. It requires commitment, which comes from a sense of urgency and a sense of possibility.
One way to develop a sense of urgency is to translate rates into numbers – i.e., actual patients. For example, in this study, surgical site infections accounted for 19.5% of the unplanned readmissions. Even though this only represents 1% of the 498,875 ACS NSQIP patients undergoing surgery in 2012, that 1% equals 5,565 patients. Reducing that number by half would reduce pain and suffering for more than 2,700 patients. If similar success were achieved nationwide, the total would be many times that.
Dr. Lucian L. Leape is with the department of health policy and management at Harvard School of Public Health, Boston, and made these comments in an accompanying editorial (doi:10.1001/jama.2014.18666). He reported having no relevant financial disclosures.
These findings provide an unprecedented opportunity to apply these lessons and make substantial reductions in surgical complications, Dr. Lucian L. Leape said in an editorial accompanying the study.
Changing systems is hard work and requires serious commitment. Changing hospital systems is especially difficult because of long-standing traditions and entrenched practices. Successful change requires leadership by those with the will, the determination, and the perseverance to overcome obstacles and motivate colleagues. It requires commitment, which comes from a sense of urgency and a sense of possibility.
One way to develop a sense of urgency is to translate rates into numbers – i.e., actual patients. For example, in this study, surgical site infections accounted for 19.5% of the unplanned readmissions. Even though this only represents 1% of the 498,875 ACS NSQIP patients undergoing surgery in 2012, that 1% equals 5,565 patients. Reducing that number by half would reduce pain and suffering for more than 2,700 patients. If similar success were achieved nationwide, the total would be many times that.
Dr. Lucian L. Leape is with the department of health policy and management at Harvard School of Public Health, Boston, and made these comments in an accompanying editorial (doi:10.1001/jama.2014.18666). He reported having no relevant financial disclosures.
Surgical site infection and ileus were the most frequent reason for hospital readmission within 30 days, according to an analysis of data from the National Surgical Quality Improvement Program.
The findings, published online in the Feb. 3 JAMA, suggest that policies that penalize hospitals for readmissions may be ineffective and potentially counterproductive.
Dr. Karl Y. Bilimoria of Northwestern University, Chicago, and his colleagues examined patient data from 346 hospitals participating in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) between January 2012 and December 2012. Readmission rates and reasons were assessed for all surgical procedures and for six representative operations: bariatric surgery, colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass (JAMA 2015;313;483-95 [doi:10.1001/jama.2014.18614]).
Of the 498, 875 patient sample, the overall readmission rate was 5.7%. For individual procedures, the readmission rate ranged from 3.8% for hysterectomy to 14.9% for lower extremity vascular bypass.
The most common reason for readmission was surgical site infection (SSI; 19.5%), ranging from 11.4% after bariatric surgery to 36.4% after lower extremity vascular bypass. Ileus was the most common reason for readmission after bariatric surgery (24.5%) and the second most common reason overall (10.3%). Other common causes for readmission included dehydration or nutritional deficiency, bleeding or anemia, venous thromboembolism, and prosthesis or graft issues (after arthroplasty and lower extremity vascular bypass procedures). Only 2% of patients were readmitted for the same complication they had experienced during their index hospitalization. Just 3% of patients readmitted for SSIs had experienced an SSI during their index hospitalization.
The results show readmissions after surgery may not be an appropriate measure for pay-for-performance and cost-containment programs, such as the Centers for Medicare & Medicaid Service’s Hospital Readmissions Reduction Program, Dr. Bilimoria said. Performance targets without accepted courses of intervention might be more prone to unintended or ineffective behaviors and consequences, he noted.
“Surgical readmissions mostly reflect postdischarge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI,” he said. “Efforts should focus on reducing complication rates overall than simply those that occur after discharge, and this will subsequently reduce readmission rates as well.”
On Twitter @legal_med
Surgical site infection and ileus were the most frequent reason for hospital readmission within 30 days, according to an analysis of data from the National Surgical Quality Improvement Program.
The findings, published online in the Feb. 3 JAMA, suggest that policies that penalize hospitals for readmissions may be ineffective and potentially counterproductive.
Dr. Karl Y. Bilimoria of Northwestern University, Chicago, and his colleagues examined patient data from 346 hospitals participating in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) between January 2012 and December 2012. Readmission rates and reasons were assessed for all surgical procedures and for six representative operations: bariatric surgery, colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass (JAMA 2015;313;483-95 [doi:10.1001/jama.2014.18614]).
Of the 498, 875 patient sample, the overall readmission rate was 5.7%. For individual procedures, the readmission rate ranged from 3.8% for hysterectomy to 14.9% for lower extremity vascular bypass.
The most common reason for readmission was surgical site infection (SSI; 19.5%), ranging from 11.4% after bariatric surgery to 36.4% after lower extremity vascular bypass. Ileus was the most common reason for readmission after bariatric surgery (24.5%) and the second most common reason overall (10.3%). Other common causes for readmission included dehydration or nutritional deficiency, bleeding or anemia, venous thromboembolism, and prosthesis or graft issues (after arthroplasty and lower extremity vascular bypass procedures). Only 2% of patients were readmitted for the same complication they had experienced during their index hospitalization. Just 3% of patients readmitted for SSIs had experienced an SSI during their index hospitalization.
The results show readmissions after surgery may not be an appropriate measure for pay-for-performance and cost-containment programs, such as the Centers for Medicare & Medicaid Service’s Hospital Readmissions Reduction Program, Dr. Bilimoria said. Performance targets without accepted courses of intervention might be more prone to unintended or ineffective behaviors and consequences, he noted.
“Surgical readmissions mostly reflect postdischarge complications, and readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI,” he said. “Efforts should focus on reducing complication rates overall than simply those that occur after discharge, and this will subsequently reduce readmission rates as well.”
On Twitter @legal_med
Key clinical point: The majority of 30-day readmissions after surgery are associated with new postdischarge complications and not the worsening of medical conditions patients had when initially hospitalized.
Major finding: Of 498,875 patients, the overall unplanned readmission rate was 5.7%. Only 2% of patients were readmitted for the same complication they had experienced during their index hospitalization. The most common reason for readmission was surgical site infections (19.5%).
Data source: A study of 346 hospitals participating in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS NSQIP) between January and December 2012.
Disclosures: The investigators reported no relevant conflicts of interest.
