The Revolving Door? New York State Hospital Readmission Following Hysterectomy for Benign Conditions [6H

Abstract

INTRODUCTION: As health care costs rise, hospital readmission remains a target for reform. Hysterectomy is the most common major gynecologic procedure performed in the U.S. Determining the readmission rate, cost, and factors related to readmission is critical to define the scope of the problem and identify areas for improvement. METHODS: The New York Statewide Planning and Research Cooperative System database collects patient encounter data across hospitals. Data were analyzed for hysterectomies performed for non-urogynecologic, benign indications from 2007-2014. Factors analyzed included: patient and procedure characteristics, hospital academic status, and annual surgical volume by hospital and surgeon. A multivariable logistic regression model was used to evaluate the independent predictors for 30-day readmission. RESULTS: Overall 132,943 unique hysterectomy encounters were analyzed with a total of 5,896 (4.43%) hospital readmissions. Black race, Medicare/Medicaid insurance, academic medical center status, total hysterectomy, minimally invasive procedures, comorbidities, postoperative complications, and longer length of stay were found to be significantly associated with increased risk of hospital readmission. Infectious Disease was the leading diagnosis (28.67%) for readmission. The mean hospital charge for readmission was $30,132, with a median of $18,072, and an 8-year total of $177,658,508. CONCLUSION: The significant prevalence and cost of hospital readmission following hysterectomy merit efforts for reduction. As postoperative infections were identified as a leading cause for readmission, attention should be paid to following American College of Obstetricians and Gynecologists and hospital-directed guidelines to minimize infectious risk. A more in-depth analysis of surgical case complexity may shed light on why academic medical center status was correlated with increased readmission risk.