G. D. Sacks1,2, M. M. Gibbons1, S. O. Raetzman4, M. L. Barrett5, P. L. Owens3, C. A. Steiner3 1University Of California – Los Angeles,Surgery,Los Angeles, CA, USA 2Robert Wood Johnson Clinical Scholars Program, UCLA,Los Angeles, CA, USA 3Agency For Healthcare Research And Quality (AHRQ),Center For Delivery, Organization And Markets (CDOM),Rockville, MD, USA 4Truven Health Analytics,Bethesda, MD, USA 5ML Barrett, Inc,Del Mar, CA, USA
Introduction:
Revisits to health care settings following inpatient hospitalization, particularly those resulting in hospital readmission, have emerged as an indicator of health care quality. The prevalence and etiology of revisits following ambulatory surgery, however, remain unknown.
Methods:
We performed a retrospective analysis using the 2010-2011 Healthcare Cost and Utilization Project State Ambulatory Surgery, Inpatient, and Emergency Department Databases for 7 geographically dispersed states (California, Florida, Georgia, Missouri, Nebraska, New York, and Tennessee) of index operations representing a broad range of specialties: laparoscopic cholecystectomy (LC), abdominal hernia repair (AHR), anterior cruciate ligament repair (ACLR), spine surgery (SS), hysterectomy (HYST), and transurethral retrograde prostatectomy (TURP) in low surgical risk adults (defined as no acute care visit in previous 30 days, length of stay less than 2 days, no other surgery on the same day, no infection coded and discharged home the same day). We identified cases resulting in a revisit within 30 days of an operation to the emergency department (ED), hospital-owned ambulatory surgery setting (AS), or inpatient (IP) setting. Rates, site, and reason for revisit were analyzed.
Results:
Of the 482,034 index operations, revisits occurred after 45,760 surgeries (9.5%). The majority of revisits were to the ED (n=28,302, 61.8%), followed by IP readmissions (n=13,027, 28.5%). Few revisits were to an AS (n=4,431, 9.7%). Revisits were most common following TURP (14.5%) and AHR (10.9%) and least common for ACLR (5.1%). Across all operations, medical complications of surgery accounted for 42.1% of revisits, surgical complications for 26.6%, and 31.3% were for clinical issues unrelated to the index operation. The distribution of each revisit type varied by operation. Medical complications were the most common reason for revisit following LC (50.3%), AHR (39.6%), and HYST (43.3%), while surgical complications were most common for ACLR (35.5%), SS (36.6%), and TURP (56.6%). Unrelated readmissions ranged from 23.1% for TURP to 39.6% for AHR. Similarly, the distribution of revisit setting varied by operation.
Conclusion:
Health care revisits following ambulatory surgery in low risk patients occur with significant frequency across a wide variety of operations. Most revisits were either surgically or medically related to the operation, although one-third of revisits were for clinical issues unrelated to the index operation. Considering the burden associated with revisits, these findings highlight the importance of expanding the focus of health policy interventions and local quality improvement efforts targeting revisits to include ambulatory surgery patients.
