General and vascular surgery readmissions: a systematic review.

Abstract

Hospital readmissions following surgical procedures are disruptive for patients and their families and correlates with poor outcomes including reoperation or death. Whereas readmissions following hospitalization for acute medical conditions have been the subject of ongoing research and policy initiatives for many years, readmissions have received less attention in the surgical specialties. This is remarkable given the frequency of surgery in this country, the overall cost of surgical care, and the perceived association between surgical readmission and quality of care.(1–3) Moreover, the health care costs associated with readmissions are substantial. Unplanned readmissions have an economic impact estimated at $17.4 billion per year.(1) Although debatable, a significant portion of hospital readmissions may be preventable.(2,4) Consequently, in 2010, the Patient Protection and Affordable Care Act was passed which contained legislation mandating a national readmissions reduction program.(5) Shortly thereafter, the Centers for Medicare and Medicaid Services (CMS) developed and implemented policies to penalize readmission.(6) Specifically, these penalties reduce reimbursement to hospitals with higher-than-expected readmission rates. These penalties have been already implemented for three medical diagnoses: congestive heart failure, myocardial infarction, and pneumonia, and will be expanded to the surgical procedures including hip and knee arthroplasty beginning in 2015.(6) Comprehensive reviews have addressed global aspects of readmission or readmission of patients following medical hospitalization. However, there are no systematic reviews that address surgical readmissions. In a review of interventions aimed to reduce medical readmissions, Hansen et al concluded that no single intervention was consistently associated with a reduced risk, but did note that certain components (e.g. post discharge telephone call) were common to successful bundled interventions.(7) Kansagara et al performed a systematic review of risk prediction models for readmission and determined that current models perform poorly, concluding that efforts are needed to improve their performance, including measures of patient’s social support and detailed clinical data.(8) These analyses help underscore the need for research in surgical readmissions since: (1) there is no synthesis of the current literature describing surgical readmission, (2) medical readmissions are fundamentally different from surgical readmissions, and (3) there are no proven models for predicting or preventing surgical readmissions. In this review, recent studies of readmission within the surgical subspecialties of vascular, general, bariatric, and colorectal surgery are analyzed. Readmission rates and diagnoses as well as predictors of readmission are examined within these surgical fields to help create a foundation for future research that will ultimately improve the quality of surgical care.