J. D. Dieterich1, C. Divino1 1Mount Sinai School Of Medicine,Divison Of General Surgery, Department Of Surgery,New York, NY, USA
Introduction:
Since the enactment of the Affordable Care Act, unplanned patient readmissions have become increasingly scrutinized. Readmissions place a large economic burden on hospitals and negatively impact the quality of life for patients. Elderly patients, in particular, suffer a disproportionate amount of complications from any kind of hospitalization, including readmissions. This study seeks to identify risk factors in this population that predispose them to an unplanned readmission within 30 days following index surgery.
Methods: The National Surgical Quality Improvement Program (NSQIP) database was used to select patients 65 and older, who underwent general surgery procedures in 2012. Patient demographics, comorbidities, complications, and readmissions were analyzed. NSQIP measures 30-day readmissions starting from the date of surgery. However, Medicare tracks readmissions 30 days after hospital discharge. To compensate for the variable patient length of stay, a Cox regression survivorship model was employed for multivariate analysis.
Results: Nine thousand four hundred and eighty three patients were reviewed. Seven hundred and seventy (7.8%) had an unplanned readmission within 30 days of their operation. Cox regression revealed five different independent predictors of unplanned readmission within 30 days. They are: any postoperative complication (p<0.001, 1.34 Hazard Ratio (HR), 1.16-1.68 95% Confidence Interval (CI)), operation time (p=0.004, 1.001 HR, 1.000-1.002 95% CI), age (p=0.01, 1.02 HR, 1.01-1.03 95% CI), esophageal varices (p=0.013, 12.12 HR, 1.68-87.30 95% CI), and CNS tumor (p=0.004, 20.86 HR, 2.67-163.28 95% CI).
Conclusion: Using Cox regression to adjust for patient length of stay, any complication, age, esophageal varices, CNS tumors, and operation time all independently increased the rate of unplanned readmissions. These results may urge providers to monitor or retain elderly surgery patients who suffer a postoperative complication.
