Psychosocial Determinants of Readmission After Surgery. Med Care 2021 Oct 01;59(10):864-871
Date
06/22/2021Pubmed ID
34149017Pubmed Central ID
PMC8425630DOI
10.1097/MLR.0000000000001600Scopus ID
2-s2.0-85115384268 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
BACKGROUND: Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood.
OBJECTIVE: We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population.
RESEARCH DESIGN: This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital.
SUBJECTS: We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015-June 30, 2017).
MEASURES: We assessed unplanned readmission to any medical facility within 30 days of hospital discharge.
RESULTS: A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery.
CONCLUSIONS: Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient's mental health and social support needs will affect recovery.
Author List
Graham LA, Hawn MT, Dasinger EA, Baker SJ, Oriel BS, Wahl TS, Richman JS, Copeland LA, Itani KMF, Burns EA, Whittle J, Morris MSAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedFemale
General Surgery
Hospitals, Veterans
Humans
Interviews as Topic
Male
Middle Aged
Patient Readmission
Patients
Postoperative Period
Prospective Studies
Qualitative Research
