Variation in readmission expenditures after high-risk surgery

Abstract

Background The Hospital Readmissions Reduction Program reduces payments to hospitals with excess readmissions for three common medical conditions and recently extended its readmission program to surgical patients. We sought to investigate readmission intensity as measured by readmission cost for high-risk surgeries and examine predictors of higher readmission costs. Materials and Methods We used the Healthcare Cost and Utilization Project's State Inpatient Database to perform a retrospective cohort study of patients undergoing major chest (aortic valve replacement, coronary artery bypass grafting, lung resection) and major abdominal (abdominal aortic aneurysm repair [open approach], cystectomy, esophagectomy, pancreatectomy) surgery in 2009 and 2010. We fit a multivariable logistic regression model with generalized estimation equations to examine patient and index admission factors associated with readmission costs. Results The 30-day readmission rate was 16% for major chest and 22% for major abdominal surgery (p<0.001). Discharge to a skilled nursing facility was associated with higher readmission costs for both chest (OR 1.99; 95% CI 1.60-2.48) and abdominal surgeries (OR 1.86; 95% CI 1.24-2.78). Comorbidities, length of stay, and receipt of blood or imaging was associated with higher readmission costs for chest surgery patients. Readmission >3 weeks after discharge was associated with lower costs among abdominal surgery patients. Conclusions Readmissions after high-risk surgery are common, affecting about one in six patients. Predictors of higher readmission costs differ among major chest and abdominal surgeries. Better identifying patients susceptible to higher readmission costs may inform future interventions to either reduce the intensity of these readmissions or eliminate them altogether.

Time Spent Away from Home in the Year Following High‐Risk Cancer Surgery in Older Adults

“…Data are stratified by discharge destination (ie, to home or to a facility) and are adjusted for procedure type, age, sex, race, Charlson score, preadmission disposition, and calendar year. pancreatectomy) and found that 19.4% of patients were discharged to a skilled nursing facility, 3 which is similar to the rate of 22.8% found in this study. Another study looked at 30-day readmission intensity in cystectomy patients using Surveillance, Epidemiology, and End Results-Medicare data and found that 77% of readmissions occurred within the first week of discharge.…”

“…The existing literature is mainly limited to 30‐day readmissions and to initial hospital discharge destination following these high‐risk cancer surgeries. One study using data from the Healthcare Cost and Utilization Project's State Impatient Database examined patients undergoing similarly high‐risk abdominal surgery (including open abdominal aortic aneurysm repair, cystectomy, esophagectomy, and pancreatectomy) and found that 19.4% of patients were discharged to a skilled nursing facility, which is similar to the rate of 22.8% found in this study. Another study looked at 30‐day readmission intensity in cystectomy patients using Surveillance, Epidemiology, and End Results‐Medicare data and found that 77% of readmissions occurred within the first week of discharge .…”

“…The overwhelming majority of these patients survive the hospital admission during which the surgery is performed; however, greater than 10% are discharged to a nursing home for skilled needs, 1,2 and 10% to 22% will be readmitted to the hospital within 30 days. [3][4][5][6][7][8][9] Although these statistics during the early postoperative period are concerning, little is known about where these individuals spend their time beyond the 30-day postoperative period. High rates of complications following these procedures, upward of 20% to 50%, [10][11][12][13] make it likely that patients will continue to require high levels of care, potentially requiring time spent in either in the hospital or in a nursing home.…”

“…Although many choose to undergo high‐risk surgery for their cancer diagnoses, the recovery following such surgery can be long and arduous. The overwhelming majority of these patients survive the hospital admission during which the surgery is performed; however, greater than 10% are discharged to a nursing home for skilled needs, and 10% to 22% will be readmitted to the hospital within 30 days …”

Reversal of rocuronium-induced neuromuscular block: is it time for sugammadex to replace neostigmine?

“…abdominal aortic aneurysm repair, cystectomy, oesophagectomy, and pancreatectomy), based on analyses of inpatient databases for NY, IA, NC, and WA states in USA. 16 Furthermore, Wilbur and colleagues 13 reported a mean cost of $25 416 per readmission (total readmission-related costs during the study period were $4 523 959). Based on these reports, sugammadex may yield considerable economic benefits despite the higher direct costs of reversing moderate rocuronium-induced NMB with sugammadex compared with neostigmine.…”