Risk Factors for Readmission After Elective Colectomy

Kerwel, Therese G.; Leichtle, Stefan W.; Asgeirsson, Theodor; Hendren, Samantha; Cleary, Robert K.; Luchtefeld, Martin

doi:10.1097/dcr.0000000000000007

Cited by 32 publications

(7 citation statements)

References 21 publications

(22 reference statements)

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“…Most of the current literature on the topic of patient satisfaction and safety results has been published using data from medical patients with pneumonia, acute myocardial infarction, and congestive heart failure, 10, 11 while in this study we identified patients who had been discharged from a surgical service. It is well known that most surgical readmissions are due to postoperative complications, 12-16 while medical patients are most frequently readmitted for recurrence or exacerbation of the underlying medical condition treated during the index hospitalization. 17-19 These differences highlight challenges in comparing patient outcomes between medical and surgical patients.…”

Section: Discussionmentioning

confidence: 99%

Is There a Relationship Between Patient Satisfaction and Favorable Outcomes?

Kennedy

Tevis²,

Kent³

2014

Annals of Surgery

200

151

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Objective Patient satisfaction with the health care experience has become a top priority for Centers for Medicare and Medicaid Services. With resources and efforts directed at patient satisfaction, we evaluated whether high patient satisfaction measured by HCAHPS surveys correlates with favorable outcomes. Methods Medical centers were identified from the University HealthSystem Consortium database from 2011–2012. Variables included hospital characteristics, process measure compliance, and surgical outcomes. Chi-squared analysis was used to evaluate for variables associated with high patient satisfaction (defined as hospitals that scored above the 50th percentile of top box scores). Results We identified 171 hospitals with complete data. The following variables were significantly associated with high overall patient satisfaction: large hospitals, high surgical volume, and low mortality (p < 0.001). Compliance with process measures and patient safety indicators, as well as length of stay, did not correlate with overall satisfaction. The presence of complications (p = 0.491) or increased rate of readmission (p = 0.056) were not found to affect patient satisfaction. Low mortality index was consistently found to be associated with high satisfaction across 9 of 10 HCAHPS domains. Conclusions We found that hospital size, surgical volume and low mortality were associated with high overall patient satisfaction. However, with the exception of low mortality, favorable surgical outcomes were not consistently associated with high HCAHPS scores. With existing satisfaction surveys, we conclude that factors outside of surgical outcomes appear to influence patients' perceptions of their care.

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Section: Discussionmentioning

confidence: 99%

Is There a Relationship Between Patient Satisfaction and Favorable Outcomes?

Kennedy

Tevis²,

Kent³

2014

Annals of Surgery

200

151

View full text Add to dashboard Cite

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“…Several studies have attempted to identify risk factors for readmission after abdominal surgery in general [ 8 ], colorectal [ 9 – 12 ] and hepato-pancreato-biliary surgery [ 13 – 15 ], however, there is a paucity of information that focuses on readmission rates and associated risk factors for readmission after gastrectomy for patients with gastric cancer. Gastrectomy is frequently performed in malnourished patients, which can be associated with a higher incidence of postoperative complications [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

et al. 2015

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BackgroundHospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.MethodsWe conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined.ResultsA total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition.ConclusionsReadmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.

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“…Previous studies were centered on fewer parts of the perioperative care continuum with a shorter list of re-admission variables, including some that did not consider complications after discharge [11, 13–15]. Patient demographics like socioeconomic and race equity are the focus of a CMS Medicare initiative [17, 18].…”

Section: Discussionmentioning

confidence: 99%

“…Other investigators have also emphasized the relationship between post-operative complications identified after discharge and re-admissions [11, 13–15]. One found that post-discharge complications had higher odds for re-admission (61-fold) than complications evident prior to discharge (twofold) [13].…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for re-admission are complex and change from admission to discharge and follow-up, and studies to date do not include all categories of re-admission predictor variables [10]. Current statistical models to evaluate re-admissions after surgery are variable with respect to the number and type of predictors, with some centered on patient demographics and comorbidities and others focused on post-operative complications [11–15]. There is a need for a comprehensive statistical re-admission predictor model incorporating all known risk factor patient categories.…”

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confidence: 99%

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