Emergency Department Utilization and Readmissions Following Major Surgery: A Retrospective Study of Medicare Data. J Surg Res 2021 Sep;265:187-194
Date
05/05/2021Pubmed ID
33945926DOI
10.1016/j.jss.2021.02.052Scopus ID
2-s2.0-85104997373 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
BACKGROUND: Reliable strategies for reducing postoperative readmissions remain elusive. As the emergency department (ED) is a frequent source of post-operative admissions, we investigated whether hospitals with high readmission rates also have high rates of post-discharge ED visits and high rates of readmission once an ED visit occurs.
METHODS: We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing 1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. We stratified hospitals into quintiles based on risk-standardized, 30-day post-discharge readmission rates (RSRR) and then compared rates of post-discharge ED visits, proportion readmitted from the ED, and readmissions within 7 days of ED discharge across these quintiles.
RESULTS: RSRR varied widely across extremes of hospital quintiles (3.9% to 17.5%). Hospitals with either very low or very high RSRR had modest differences in rates of ED visits (12.4% versus 14.6%). In contrast, the proportion readmitted from the ED was nearly 3 times greater in Hospitals with very high RSRR compared with those with very low RSRR (12% versus 32.2%). These findings were consistent across all procedures. Importantly, hospitals with a low proportion readmitted from the ED did not exhibit an increased rate of readmission within 7 days of ED discharge.
CONCLUSIONS: Although hospitals experience similar rates of ED visits following major surgery, some EDs and their affiliated surgeons and health system may deliver care preventing readmissions without an increased short-term risk of readmission following ED discharge. Reducing 30-day readmissions requires greater attention to the coordination of care delivered in the ED.
Author List
Dev S, Gonzalez AA, Ghaferi AA, Nallamothu BK, Kocher KEAuthor
Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedEmergency Service, Hospital
Epidemiologic Studies
Female
Hospitals
Humans
Male
Medicare
Patient Readmission
Postoperative Complications
Surgical Procedures, Operative
United States
