Readmissions after general surgery: a prospective multicenter audit

Lee, Matthew J.; Daniels, Sarah; Wild, Jonathan; Wilson, Timothy R.; Jackson, Andrew C.; Shun, Claire Kok; Wheeler, Alexandre; West, Rebecca; Nofal, Emma; Proctor, Victoria; Rigby, Matthew H.; Burnett, Heather; Gaikwad, Raj; Madhbak, Khalil; Flatt, Eli; Akram, Farah

doi:10.1016/j.jss.2016.09.020

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…Type of operation and complexity were recorded according to the BUPA classification 2223. BUPA categorises all commonly performed surgical procedures into five complexity grades (minor, intermediate, major, major plus, and complex major; supplementary table S15) and has been used previously for scientific purposes 2526…”

Section: Methodsmentioning

confidence: 99%

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Dell-Kuster

Gomes

Gawria

et al. 2020

BMJ

138

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Objective To prospectively assess the construct and criterion validity of ClassIntra version 1.0, a newly developed classification for assessing intraoperative adverse events. Design International, multicentre cohort study. Setting 18 secondary and tertiary centres from 12 countries in Europe, Oceania, and North America. Participants The cohort study included a representative sample of 2520 patients in hospital having any type of surgery, followed up until discharge. A follow-up to assess mortality at 30 days was performed in 2372 patients (94%). A survey was sent to a representative sample of 163 surgeons and anaesthetists from participating centres. Main outcome measures Intraoperative complications were assessed according to ClassIntra. Postoperative complications were assessed daily until discharge from hospital with the Clavien-Dindo classification. The primary endpoint was construct validity by investigating the risk adjusted association between the most severe intraoperative and postoperative complications, measured in a multivariable hierarchical proportional odds model. For criterion validity, inter-rater reliability was evaluated in a survey of 10 fictitious case scenarios describing intraoperative complications. Results Of 2520 patients enrolled, 610 (24%) experienced at least one intraoperative adverse event and 838 (33%) at least one postoperative complication. Multivariable analysis showed a gradual increase in risk for a more severe postoperative complication with increasing grade of ClassIntra: ClassIntra grade I versus grade 0, odds ratio 0.99 (95% confidence interval 0.69 to 1.42); grade II versus grade 0, 1.39 (0.97 to 2.00); grade III versus grade 0, 2.62 (1.31 to 5.26); and grade IV versus grade 0, 3.81 (1.19 to 12.2). ClassIntra showed high criterion validity with an intraclass correlation coefficient of 0.76 (95% confidence interval 0.59 to 0.91) in the survey (response rate 83%). Conclusions ClassIntra is the first prospectively validated classification for assessing intraoperative adverse events in a standardised way, linking them to postoperative complications with the well established Clavien-Dindo classification. ClassIntra can be incorporated into routine practice in perioperative surgical safety checklists, or used as a monitoring and outcome reporting tool for different surgical disciplines. Future studies should investigate whether the tool is useful to stratify patients to the appropriate postoperative care, to enhance the quality of surgical interventions, and to improve long term outcomes of surgical patients. Trial registration ClinicalTrials.gov NCT03009929 .

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Section: Methodsmentioning

confidence: 99%

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Dell-Kuster

Gomes

Gawria

et al. 2020

BMJ

138

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“…Intraoperative variables included type of procedure, wound classification, length of procedure and operative approach. Procedure complexity was defined as minor, intermediate and major, and complex as per the BUPA classification, 23 which has been utilized previously in literature 24 . Wound classifications included clean, clean‐contaminated, contaminated, and dirty.…”

Section: Methodsmentioning

confidence: 99%

“…Procedure complexity was defined as minor, intermediate and major, and complex as per the BUPA classification, 23 which has been utilized previously in literature. 24 Wound classifications included clean, clean-contaminated, contaminated, and dirty. Postoperative variables included hospital length of stay (LOS) and postoperative complications.…”

Section: Methodsmentioning

confidence: 99%

Reducing unplanned general surgical readmissions: a review of the Australian and New Zealand National Surgical Quality Improvement Program Database

Pham

Chen

Hitos

et al. 2022

ANZ Journal of Surgery

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Background Unplanned surgical readmissions are an important indicator of quality care and are a key focus of improvement programs. The aims of this study were to evaluate the factors that lead to unplanned hospital readmissions in patients undergoing general surgical procedures and to identify preventable readmissions. Methods A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2016 to 2020 at a tertiary hospital was conducted to identify patients undergoing a general surgical procedure. Various perioperative parameters were studied to identify risk factors and reasons for unplanned readmission. Preventable readmissions were identified. Results A total of 3069 patients underwent a general surgical procedure. Of these, the overall unplanned readmission rate was 8.8% (n = 247). The most common reason for readmission was associated with surgical site infections (n = 112, 44.3%) followed by pain (n = 50, 20.2%), with over 45% deemed as preventable readmissions. Factors associated with increased risk of readmission included older age, longer index length of stay, prolonged operative time, elective procedures, higher ASA score and contaminated procedures. Conclusion Unplanned readmissions are more likely to occur in patients who develop postoperative complications. Understanding factors associated with readmissions may facilitate targeted quality improvement projects that reduce hospital readmission after surgery.

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“…The presence of cancer or dyspnea, complexity of the surgery, and respiratory complications were found to be the most important risk factors [14]. Two studies conducted in the UK at an interval of about 10 years found this rate as 6.8% and 4.7% and reported the most important reasons for readmission as surgical infections (57%) and postoperative pain (29%) [15]. A study from China found the rate of readmission after colorectal surgery as 18.6% and reported the presence of preoperative comorbidity as the most important risk factor [16,17].…”

Section: Interpretation Within the Context Of The Wider Literaturementioning

confidence: 99%

Analysis of unplanned revisits and readmissions: results of the General Surgery clinic in a private hospital

Narmanlı

Özgüç

Çevikkalp

et al. 2022

The European Research Journal

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Objectives:In recent years, the rate of readmission (RA) within the first thirty days of discharge has been an important parameter for cost and quality standards. It is therefore extremely important for each center to analyze its own results and determine the factors affecting the RA rates in order to organize the measures to be taken. Another important issue, especially for centers focusing on specific areas of expertise, is unplanned revisit (RV) after discharge. Determination of these rates and reasons is of importance for every hospital and/or clinic to decrease these rates, thus increasing patient satisfaction and reducing costs. The aim of this study was to analyze RA and RV patients operated in the general surgery clinic of our hospital for a period of two years as well as factors affecting these rates. Methods: The study included patients who were operated in the general surgery clinic of Bursa Private Medicabil Hospital between 1 January 2018 and 31 December 2019 and who revisited and were readmitted within the first thirty days of discharge. The reasons for RA/RV and time to RA/RV, and patients' treatments were investigated by comparing RA/RV patients with those who were not readmitted (NA) for demographic results at initial admission to determine the differences between these patient groups. Univariate and multivariate analyses were carried out using the SPSS software. The level of significance was set at p < 0.05. Results: Of the 890 patients who were operated in our clinic throughout the study period and met the study inclusion criteria, 52 (5.8%) were included in the unplanned RA group and 107 (12%) in the unplanned RV group. The mean time to RA was 10.5 ± 7.0 days for the RV group and 8.8 ± 6.7 days for the RA group (p = 0.17). Thirty-two (61.5%) of the RA patients and 41 (38.3%) of the RV patients were readmitted within the first 7 days of discharge (p = 0.003). The multivariate analysis revealed that prolonged length of hospital stay, emergency surgery, abnormal WBC, electrolyte imbalance, and abnormal hemoglobin level were significant risk factors for RV, while the development of complications, prolonged length of hospital stay, and advanced age were significant risk factors for RA. Conclusions: This study analyzing the RA and RV patients operated in the general surgery clinic of a private hospital demonstrated that the most important reasons for RA were nonspecific and preventable. Patients who developed complications, had prolonged length of hospital stay, and were at an advanced age had a higher rate of RA, while patients who had prolonged length of hospital stay, underwent emergency surgery, and had biochemical problems at initial admission had a higher rate of RV. Focusing on these patients during and after discharge and increasing home care facilities can solve the problems of many patients without admitting them to the hospital. This will be a factor that would improve patient satisfaction while reducing costs.

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Readmissions after general surgery: a prospective multicenter audit

Cited by 17 publications

References 20 publications

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study

Reducing unplanned general surgical readmissions: a review of the Australian and New Zealand National Surgical Quality Improvement Program Database

Analysis of unplanned revisits and readmissions: results of the General Surgery clinic in a private hospital

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