Preventable Readmissions to Surgical Services: Lessons Learned and Targets for Improvement

Dawes, Aaron J.; Sacks, Greg D.; Russell, Marcia M.; Lin, Anne; Maggard-Gibbons, Melinda; Winograd, Deborah; Chung, Hyun-Kyung; Tillou, Areti; Hiatt, Jonathan R.; Ko, Clifford Y.

doi:10.1016/j.jamcollsurg.2014.03.046

Cited by 74 publications

(38 citation statements)

References 31 publications

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“…(14) Similarly, Dawes and colleagues estimated that only 21% of postoperative readmissions to a general surgery service were preventable. (15) Our findings suggest that with limited resources and increasing cost of healthcare, patients identified to be in the highest risk profile as previously outlined (Electronic table 1) should be prioritized in allocation of post-discharge resources like home health care, telephone calls, or early clinic visits.…”

Section: Discussionmentioning

confidence: 65%

Unexpected readmission after lung cancer surgery: A benign event?

Patel

Crabtree

Bell

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective To study incidence, predictors, and implications of unanticipated early postoperative readmission after lung resection for non-small cell lung cancer (NSCLC). Methods Patients undergoing surgery for clinical stage I–III NSCLC were abstracted from the National Cancer Database (NCDB). Regression models were fitted to identify predictors of 30-day readmission, and to study the association of unplanned readmission with 30-day and long-term survival. Results Between 1998 and 2010, 129893 patients underwent resection for stage I–III NSCLC. Of these, 5624 (4.3%) were unexpectedly readmitted within 30 days. In a multivariate regression model, increasing age, male gender, preoperative radiation, and pneumonectomy (OR 1.77, 1.56–2.00) were associated with unexpected readmissions. Longer index hospitalization and higher Charlson comorbidity score were also predictive of readmission. The 30-day mortality for readmitted patients was higher (3.9% vs. 2.8%), as was the 90-day mortality (7.0% vs. 3.3%, both p<0.001). In a multivariate cox proportional hazards model of long-term survival, increasing age, higher Charlson comorbidity score, and higher pathologic stage (HR for stage III 1.81, 1.42–2.29) were associated with greater risk of mortality. Unplanned readmission was independently associated with higher risk of long-term mortality (HR 1.40, 1.34–1.47). The median survival for readmitted patients was significantly shorter (38.7 months vs. 58.5 months, p<0.001). Conclusions Unplanned readmissions are not rare after resection for NSCLC. Such events are associated with a greater risk of short- and long-term mortality. With the renewed national focus on readmissions and potential financial disincentives, greater resource allocation is needed to identify patients at risk and develop measures to avoid the associated adverse outcomes.

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Section: Discussionmentioning

confidence: 65%

Unexpected readmission after lung cancer surgery: A benign event?

Patel

Crabtree

Bell

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…The 30-day readmission rate was 7.5% (1,565 patients), which is comparable to previously reported rates in general surgery patients. (2, 8, 14, 17) Demographics, comorbidities, and surgical procedures of the patient population are fully described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…(1–3) As mandated by the Patient Protection and Affordable Care Act, CMS has begun adjusting hospital payments through the Hospital Readmissions Reduction Program according to hospitals’ rate of “excess” vs. “expected” Medicare readmissions for pneumonia, acute myocardial infarction and heart failure with a future planned expansion into surgical patients. (2, 4–7) Previous estimates suggest that even a small reduction of 5% in readmission rates could prevent over 2,000 inpatient hospitalizations with Medicare cost savings of $31 million. (8)…”

Section: Introductionmentioning

confidence: 99%

Discharge decision-making after complex surgery: Surgeon behaviors compared to predictive modeling to reduce surgical readmissions

Leeds

Sadiraj

Cox

et al. 2017

The American Journal of Surgery

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Structured Abstract BACKGROUND Little is known about how information available at discharge affects decision-making and its effect on readmission. We sought to define the association between information used for discharge and patients’ subsequent risk of readmission. METHODS 2009–2014 patients from a tertiary academic medical center’s surgical services were analyzed using a time-to-event model to identify criteria that statistically explained the timing of discharges. The data were subsequently used to develop a time-varying prediction model of unplanned hospital readmissions. These models were validated and statistically compared. RESULTS The predictive discharge and readmission regression models were generated from a database of 20,970 patients totaling 115,976 patient-days with 1,565 readmissions (7.5%). 22 daily clinical measures were significant in both regression models. Both models demonstrated good discrimination (C statistic = 0.8 for all models). Comparison of discharge behaviors versus the predictive readmission model suggested important discordance with certain clinical measures (e.g., demographics, laboratory values) not being accounted for to optimize discharges. CONCLUSIONS Decision-support tools for discharge may utilize variables that are not routinely considered by healthcare providers. How providers will then respond to these atypical findings may affect implementation.

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“…Potentially preventable hospitalizations are defined as unnecessary hospitalizations despite the possibility of outpatient treatment (1). These hospitalizations can also be due to unnecessary or arbitrary practices.…”

Section: Definitionmentioning

confidence: 99%

“…They are the hospital applications that can be avoided with the proper management of the patient's hospital admissions, correct discharge planning developed during or after the discharge, advanced care planning, and regular followups. These can also be defined as the hospitalizations that can be prevented in outpatient clinics, in home environments, in nursing homes, or in long-term care centers with effective, fast, and patient-oriented practices (1,3,4).…”

Section: Definitionmentioning

confidence: 99%

Preventable Hospitalizations in Older Adults: A Dream or Reality?

Naharci¹

2017

Istanbul Med J

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An 84-year-old male patient applied to a primary care clinic with the complaint of left hip pain. The patient was diagnosed with myalgia and was given nonsteroidal anti-inflammatory drug (NSAID) (dexketoprofen) and muscle relaxant (feniramidol). After 1 week, the patient was brought to the emergency service due to anorexia and nausea by his relatives. He had been continuously using escitalopram 10 mg and rivastigmine patch 10 cm 2 for depression and dementia comorbidities. According to the laboratory investigations, it was seen that serum creatinine was 2.53 mg/dL (1.07 mg/dL 3 months ago), urea was 89 mg/dL (30 mg/dL 3 months ago), and potassium was 6.02 mg/dL (3.79 mg/dL 3 months ago). The patient was hospitalized with the diagnosis of acute renal failure and dehydration. Sample Case-2A 78-year-old female patient applied to the emergency care unit with the complaints of fever, cough, and respiratory disorder. It was found out that the patient had chronic obstructive pulmonary disease (COPD) and hypertension in her history. In physical examination, O 2 saturation was found to be 86%, arterial blood pressure was 95/55 mmHg, respiratory rate was 32/min, and there was a decrease in the respiratory sounds in the right lower lung zone. After the posteroanterior chest X-ray showed an infiltration zone on the right, the patient was hospitalized with the diagnosis of pneumonia and intravenous antibiotic therapy was started. On the second day of hospitalization, the patient had a complaint about chest pain. Clinical, laboratory, and electrocardiography (ECG) examinations were performed at the first evaluation. Following these examinations, cardiac catheterization was decided to be applied. A few days after cardiac catheterization, delirium developed in the patient with the symptoms of sudden loss of consciousness, attention disorder, and hyperactivity. The patient fell off the bed on the eighth day of hospitalization when she was in the delirium state and an intertrochanteric fracture developed in the right hip. The patient was transferred to the orthopedic clinic. After the preparation for surgery, a partial hip prosthesis replacement was performed in the patient. The Key Points• "Potentially preventable hospitalizations" are unnecessary hospitalizations despite the possibility of outpatient treatment.• Frail and old people with multiple chronic conditions are under high risk for hospitalization.• These hospitalizations put a heavy burden on the country's economy.• Heart failure, COPD, pneumonia, urinary infections, and dehydration are the most common causes.• To prevent these hospitalizations, interdisciplinary team work, discharge planning, support for drug use, and residential care are needed.Preventable Hospitalizations in Older Adults: A Dream or Reality?Preventable hospitalization is defined as hospitalization of patients in healthy conditions with the possibility of treatment by outpatient care. Preventable hospitalizations are seen commonly in patients aged 65 years or older. Congestive heart failure and chroni...

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Preventable Readmissions to Surgical Services: Lessons Learned and Targets for Improvement

Cited by 74 publications

References 31 publications

Unexpected readmission after lung cancer surgery: A benign event?

Unexpected readmission after lung cancer surgery: A benign event?

Discharge decision-making after complex surgery: Surgeon behaviors compared to predictive modeling to reduce surgical readmissions

Preventable Hospitalizations in Older Adults: A Dream or Reality?

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