Faculty Collaboration Database

Variation in readmission expenditures after high-risk surgery. J Surg Res 2017 Jun 01;213:60-68

Date

06/12/2017

Pubmed ID

28601334

Pubmed Central ID

PMC5467460

DOI

10.1016/j.jss.2017.02.017

Scopus ID

2-s2.0-85015405793 (requires institutional sign-in at Scopus site)   11 Citations

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-d 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 (odds ratio [OR]: 1.99; 95% confidence interval [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 wk 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.

Author List

Jacobs BL, He C, Li BY, Helfand A, Krishnan N, Borza T, Ghaferi AA, Hollenbeck BK, Helm JE, Lavieri MS, Skolarus TA

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Hospital Costs
Humans
Logistic Models
Male
Middle Aged
Patient Readmission
Retrospective Studies
Risk Factors
Surgical Procedures, Operative
United States
Young Adult