Readmission After Emergency General Surgery: NSQIP Review of Risk, Cause and Ideal Follow-Up

Rossi, Isolina R.; Ross, Samuel W.; May, Addison K.; Reinke, Caroline E.

doi:10.1016/j.jss.2020.11.035

Cited by 12 publications

(25 citation statements)

References 17 publications

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“…We found that having at least one postoperative complication accounted for 65% of all 30-day unplanned readmissions. Similarly, several studies have shown that infectious complications, particularly surgical site infections, are the most frequent reason for 30-day unplanned readmission following EGS procedures 4–6,9 . We also found that preoperative sepsis is markedly associated with increased odds of postoperative readmissions, which is explained by the fact that most EGS problems treated by acute care surgeons are infectious and often accompanied by postoperative surgical infections.…”

Section: Discussionsupporting

confidence: 70%

“…Interestingly, they also found that more than 20% of readmitted patients sought care at a nonindex hospital 9 . Rossi et al, 4 analyzing the NSQIP research data set (2011–2015), reported a 30-day readmission rate of 8.1%. The differences between 30-day readmission rates in our study and others may be related to differences in the data sets, methods of patient selection, and the definition of EGS used.…”

Section: Discussionmentioning

confidence: 99%

“…Small variability exists between studies depending on the data set analyzed. National Surgical Quality Improvement Project uses days after the index procedure as a measure of timing to readmission, whereas state or national administrative databases use days after discharge from the index hospitalization 4,5,9 . We expanded on these analyses by stratifying the surgical procedures according to a standardized definition of risk into low- and high-risk groups 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have attempted to identify risk factors for and address the issue of readmissions in the EGS population. They have used different data sets with inconsistent clinical data granularity, and most are not representative of a national sample 4–10 . Most importantly, most studies have not focused on determining modifiable factors to inform subsequent quality improvement efforts to decrease readmissions.…”

mentioning

confidence: 99%

See 3 more Smart Citations

A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Coimbra

Allison-Aipa

Zachary

et al. 2022

J Trauma Acute Care Surg

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Coimbra

Allison-Aipa

Zachary

et al. 2022

J Trauma Acute Care Surg

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“…The procedure with the highest likelihood of readmission is colorectal surgery, which accounts for 22% of all emergency's general surgery readmissions. 9 Results of a retrospective study in 2021 showed that 13% of 4,171,983 patients had an unexpected readmission after 30 days. Of those, 21% were admitted to a hospital that was not on the index.…”

Section: Prevalence and Risk Factors Of Readmission After Emergency S...mentioning

confidence: 99%

Readmission rates and risk factors associated with emergency surgeries

Siddiqui

Albawardi²,

Alqahtani

et al. 2022

Int J Community Med Public Health

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Emergency surgery requires complex and diversified skills and talents to execute procedures from several fields of surgery within 24 hours. The prevalence of emergency surgery is also increasing in recent times and the cohort for emergency general surgery is particularly at risk for readmission. Readmission is considered as one of the predictors of the quality of healthcare. Readmission following emergency surgery is frequent and varies greatly based on patient characteristics and diagnostic types. Readmission is associated with the significant morbidity and mortality, also adds to the increased hospital burden. Various risk factors account for the readmission. The purpose of this research is to review the available information about the readmission rates and risk factors associated with emergency surgeries. About half of patients undergoing emergency surgeries will experience a postoperative complication, and postoperative complications have a strong correlation with hospital readmission. Postoperative complications and readmission have a significant negative influence on patient quality of life and healthcare resources. Different studies have reported an increased prevalence of readmissions after emergency surgeries. Surgical site infection, increased length of hospital stays, readmission at the non-index hospital, comorbidities are some of the commonly reported risk factors of readmission. Establishment and implementation of the preventive strategies for the control of risk factors of readmission can help in reducing the readmission burden.

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Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions

Moneme,

Wirtalla,

Roberts

et al. 2023

JAMA Surg

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ImportanceThe benefit of primary care physician (PCP) follow-up as a potential means to reduce readmissions in hospitalized patients has been found in other medical conditions and among patients receiving high-risk surgery. However, little is known about the implications of PCP follow-up for patients with an emergency general surgery (EGS) condition.ObjectiveTo evaluate the association between PCP follow-up and 30-day readmission rates after hospital discharge for an EGS condition.Design, Setting, and ParticipantsThis cohort study used data from the Centers for Medicare &amp; Medicaid Services Master Beneficiary Summary File, Inpatient, Carrier (Part B), and Durable Medical Equipment files for beneficiaries aged 66 years or older who were hospitalized with an EGS condition that was managed operatively or nonoperatively between September 1, 2016, and November 30, 2018. Eligible patients were enrolled in Medicare fee-for-service, admitted through the emergency department with a primary diagnosis of an EGS condition, and received a general surgery consultation during the admission. Data were analyzed between July 11, 2022, and June 5, 2023.ExposureFollow-up with a PCP within 30 days after hospital discharge for the index admission.Main Outcomes and MeasuresThe primary outcome was readmission within 30 days after discharge for the index admission. An inverse probability weighted regression model was used to estimate the risk-adjusted association of PCP follow-up with 30-day readmission. The secondary outcome was readmission within 30 days after discharge stratified by treatment type (operative vs nonoperative treatment) during their index admission.ResultsThe study included 345 360 Medicare beneficiaries (mean [SD] age, 74.4 [12.0] years; 187 804 females [54.4%]) hospitalized with an EGS condition. Of these, 156 820 patients (45.4%) had a follow-up PCP visit, 108 544 (31.4%) received operative treatment during their index admission, and 236 816 (68.6%) received nonoperative treatment. Overall, 58 253 of 332 874 patients (17.5%) were readmitted within 30 days after discharge for the index admission. After risk adjustment and propensity weighting, patients who had PCP follow-up had 67% lower odds of readmission (adjusted odds ratio [AOR], 0.33; 95% CI, 0.31-0.36) compared with patients without PCP follow-up. After stratifying by treatment type, patients who were treated operatively during their index admission and had subsequent PCP follow-up within 30 days after discharge had 79% reduced odds of readmission (AOR, 0.21; 95% CI, 0.18-0.25); a similar association was seen among patients who were treated nonoperatively (AOR, 0.36; 95% CI, 0.34-0.39). Infectious conditions, heart failure, acute kidney failure, and chronic kidney disease were among the most frequent diagnoses prompting readmission overall and among operative and nonoperative treatment groups.Conclusions and RelevanceIn this cohort study, follow-up with a PCP within 30 days after discharge for an EGS condition was associated with a significant reduction in the adjusted odds of 30-day readmission. This association was similar for patients who received operative care or nonoperative care during their index admission. In patients aged 66 years or older with an EGS condition, primary care coordination after discharge may be an important tool to reduce readmissions.

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Readmission After Emergency General Surgery: NSQIP Review of Risk, Cause and Ideal Follow-Up

Cited by 12 publications

References 17 publications

A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

A comprehensive analysis of 30-day readmissions after emergency general surgery procedures: Are risk factors modifiable?

Readmission rates and risk factors associated with emergency surgeries

Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions

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