Incidence Of 30-day Readmission Research Articles

Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors

BACKGROUND CONTEXTAlthough outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSEThis study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEPatients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURESHospital readmission within 30 postoperative days. METHODSPatients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTSA total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSIONThis study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.

Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis.

Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery. PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model. Overall, 21 studies involving 10764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: -1.02, 95% CI: -1.41 to -0.64, P <0.00001), hospitalization costs (MD: -678.50, 95% CI: -1196.39 to -160.60, P =0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63-0.97, P =0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien-Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups. The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.

A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot Randomized Controlled Trial.

BackgroundPatients hospitalized with acute coronary syndrome (ACS) or heart failure (HF) are frequently readmitted. This is the first randomized controlled trial of a mobile health intervention that combines telemonitoring and education for inpatients with ACS or HF to prevent readmission.ObjectiveThis study aims to investigate the feasibility, efficacy, and cost-effectiveness of a smartphone app–based model of care (TeleClinical Care [TCC]) in patients discharged after ACS or HF admission.MethodsIn this pilot, 2-center randomized controlled trial, TCC was applied at discharge along with usual care to intervention arm participants. Control arm participants received usual care alone. Inclusion criteria were current admission with ACS or HF, ownership of a compatible smartphone, age ≥18 years, and provision of informed consent. The primary end point was the incidence of unplanned 30-day readmissions. Secondary end points included all-cause readmissions, cardiac readmissions, cardiac rehabilitation completion, medication adherence, cost-effectiveness, and user satisfaction. Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients’ smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients’ usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months.ResultsOverall, 164 inpatients were randomized (TCC: 81/164, 49.4%; control: 83/164, 50.6%; mean age 61.5, SD 12.3 years; 130/164, 79.3% men; 128/164, 78% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39% vs 9/49, 18%; P=.03) and medication adherence (57/76, 75% vs 37/74, 50%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus $6028 (US $4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus $100,000 (approximately US $70,000) annually.ConclusionsTCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945

A randomised control trial of TeleClinical Care – a smartphone-app based model of care for heart failure and acute coronary syndromes

Abstract Background Acute coronary syndrome (ACS) and heart failure (HF) are frequent causes of hospitalisation and readmissions. A novel smartphone app-based model of care (TeleClinical Care – TCC) was developed to support patients after ACS or HF admission. Purpose This randomised control trial aimed to characterise both the intervention and clinical outcomes. The primary endpoint was the incidence of 30-day readmissions. Secondary endpoints included six-month cardiac and all-cause readmissions, mortality, major adverse cardiovascular events (MACE), cardiac rehabilitation (CR) completion, medication adherence, serum low-density lipoprotein (LDL-C), quality of life, blood pressure, body mass index, waist circumference and six-minute walk distance. Additionally, cost-effectiveness and user satisfaction were evaluated. Methods Patients were randomised 1:1 to either TCC plus usual care or usual care alone and were followed-up at six months. Intervention arm participants received the TCC app and were asked to use Bluetooth-enabled devices for measuring weight, heart rate, blood pressure and physical activity daily. Readings were automatically transmitted to the patient's smartphone and a secure web-server (KIOLA). Customisable thresholds for each parameter were defined at discharge. Abnormal readings were flagged by email to a monitoring team, who discussed management with the patient's usual healthcare providers. The app also provided educational push notifications. Results 164 patients from two hospitals in Sydney, Australia were enrolled between February 2019 and March 2020 (TCC n=81, control n=83). Recruitment ceased during the COVID-19 pandemic. The mean age was 61.5 years. 79% of patients were male. The per-patient mean percentage of days with data transmission was 64.2±27.5%. 565 alerts were received, 16% of which resulted in additional investigations, healthcare consultation or a change in management. There was no difference in 30-day readmission rate (11 readmissions in each arm). There was a significant difference in six-month readmissions, favouring the intervention (21 vs. 41 readmissions, HR=0.40, 95% CI 0.16–0.95, P=0.03), driven by a reduction in cardiac readmissions (11 vs. 25, HR=0.51, 95% CI 0.27–0.94, P=0.03). Use of TCC was associated with improved CR completion (39% vs. 18%, P=0.025) and medication adherence (75% vs. 50%, P=0.002). There was no significant difference in mortality, MACE, LDL-C, quality of life or any of the physical parameters. The average user rating was 4.56 out of 5. The study cost EUR 4015 per readmission saved. Upon modelling, it was calculated that if the number of enrolled patients exceeds 243, total expenditure will be overcome by cost savings from reducing readmissions. Conclusion The TCC model of care was feasible and safe. In this study, clinical benefits were demonstrated including a reduction in six-month readmissions, improved CR completion and improved medication adherence. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Prince of Wales HospitalPrince of Wales Hospital Foundation Figure 1. TCC interfaceFigure 2. Cumulative readmissions over the course of the trial

Readmissions and perioperative outcomes for same-day versus next-day discharge after prolapse surgery.

We aimed to evaluate the safety of same-day discharge (SDD) compared with next-day discharge (NDD) after prolapse surgery on a national level hypothesizing that readmission and complication rates after SDD would not be higher than NDD. We performed a retrospective cohort study using the National Surgical Quality Improvement Program database including 2014-2018. Current Procedural Terminology (CPT) codes were used to identify minimally invasive apical suspensions or obliterative procedures. Exclusion criteria were length of stay > 1day, unrelated concomitant procedures, serious medical comorbidities, American Society of Anesthesiologists (ASA) Class >2, and complication during index admission. The primary outcome was 30-day readmission, and secondary outcomes included 30-day complications. 12,583 were included in analysis. SDD rate was 16.7%. The majority of women were white (91%) with a mean age of 59years and mean body mass index of 28kg/m². Medical comorbidities were similar between the SDD and NDD groups. Overall incidence of 30-day readmission was 1.7%. SDD had lower odds of 30-day readmission than NDD (aOR 0.63, 95% CI 0.41-0.98). SDD had lower odds of 30-day complications but this failed to reach statistical significance (aOR 0.67, 95% CI 0.44-1.03). In this cohort, 30-day readmission and complication rates were not higher after SDD compared to NDD in women undergoing minimally-invasive apical suspension or obliterative procedures. We interpret these findings carefully given study limitations but believe our findings support the safety of SDD after minimally invasive apical suspension or obliterative procedures in a low-risk population.

Increased Medical and Implant-Related Complications in Total Hip Arthroplasty Patients With Underlying Chronic Obstructive Pulmonary Disease

BackgroundChronic obstructive pulmonary disease (COPD) has been associated with impaired bone metabolism. The purpose of this study is to investigate rates of readmission, respiratory complications, implant-related complications, and revision after total hip arthroplasty (THA) in patients with and without underlying COPD. MethodsThe PearlDiver Mariners database was used to divide patients undergoing primary THA (CPT-27130) into two cohorts: 1) THA with COPD (including asthma) or 2) THA without COPD. The incidence of 30-day readmission, COPD exacerbation, pneumonia, other respiratory complications as well as dislocations, mechanical loosening, and joint prosthetic infection was calculated through logistic regression. The risk of THA revision was also assessed through Cox-proportional hazards regression. All regression controlled for age, gender, and medical comorbidities found to be associated with COPD. ResultsBetween 2010 and 2018, 97,784 THA patients with COPD and 338,243 THA patient without COPD were studied. THA patients with COPD had higher risk of 30-day readmission (aOR = 1.17, 95% CI 1.11-1.23, P < .0001). There was higher risk of 30-day pneumonia (aOR = 2.07, 95% CI 1.76-2.44, P < .0001). THA patients with COPD also faced higher risk of 30-day dislocations (aOR = 1.31, 95% CI 1.19-1.45, P < .0001), joint prosthetic infections (aOR = 1.25, 95% CI 1.14-1.37, P < .0001), and periprosthetic fracture (aOR = 1.19, 95% CI 1.07-1.32, P = .0015). Regarding revisions, 3.3% of THA patients with COPD underwent THA revision at 1 year, a higher risk than THA patients without COPD (aOR = 1.11, 95% CI 1.06-1.16, P < .0001). ConclusionPatients undergoing THA with underlying COPD face a higher rate of comorbidities, respiratory complications, implant complications, and revision surgeries, than patients without COPD. Level of EvidenceIII.

Effectiveness of a Geriatric Emergency Medicine Unit for the Management of Neurocognitive Disorders in Older Patients: Results of the MUPACog Study

Introduction: The prevalence of neurocognitive disorders (NCDs) increases with age and is associated with cognitive impairment. Older patients with NCD admitted to the emergency department (ED) are readmitted after discharge to home more often than those without NCD. Comprehensive geriatric assessment (CGA) is effective for improving clinical outcomes in older patients; however, the usefulness of CGA for older patients with NCD admitted to the ED has not been investigated. The main objective of our study is to assess the effectiveness of a geriatric emergency medicine unit (GEMU) for elderly patients with NCD admitted to the ED. Methods: This historical cohort study included patients aged 75 years and older with NCD admitted to the ED of Limoges University Hospital in France over a 4-year period. We compared patients treated in our hospital’s GEMU, the MUPA unit (exposed group), and patients who received standard care by emergency physicians (control group). The primary end point was the incidence of 30-day readmissions. Results: The study included 801 patients admitted to the ED between January 1, 2015, and December 31, 2018 (400 in the exposed group). Of those, 72.5% were female, and the mean age was 87 ± 5 years. After adjusting for confounding factors, the 30-day readmission rate was significantly associated with the MUPA unit intervention. Conclusion: CGA in a GEMU improved health outcomes in elderly patients with NCD in the ED. We recommend that all EDs include a geriatric team, such as the MUPA unit, to treat all patients with NCD admitted to the ED.

What Are the Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Hip Arthroplasty?

BackgroundA higher volume of primary total hip arthroplasty (THA) is starting to be performed as an outpatient procedure. However, data on appropriate patient selection for this surgical protocol is scarce. MethodsPatients who underwent primary THA were identified in the 2012-2018 National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days. The primary outcome was a readmission within the 30-day postoperative period. Risk factors for and effect of overnight hospital stay on 30-day readmission after outpatient THA were identified through multivariable models. Reasons for and timing of readmission were also identified. ResultsA total of 5245 outpatient THA patients and 44,171 patients who stayed 1 night were identified. The incidence of 30-day readmission after outpatient THA was 1.60% (95% confidence interval [CI] 1.26-1.94). Risk factors for 30-day readmission after outpatient THA include the following: older age relative to 18-60 years old (most notably 71-75 years old, relative risk [RR] = 2.3, 95% CI = 1.15-4.62; 76-80 years old, RR = 6.6, 95% CI = 3.55-12.43; and >80 years old, RR = 5.6, 95% CI = 2.43-12.89, P < .001) and bleeding disorders (RR = 4.5, 95% CI = 1.45-14.31, P = .010). For patients who had some of these risk factors, their risk of medically related 30-day readmission was reduced if they had stayed 1 night at the hospital (P < .05). The majority of readmissions were surgically related (62%), including wound complications (27%) and periprosthetic fractures (25%). ConclusionThe rate of 30-day readmission after outpatient THA was low. Patients who are at high risk for 30-day readmission after outpatient THA include those with older age and bleeding disorders. Some of these patients may benefit from an inpatient hospital stay.

Effect of Vancomycin-Associated Acute Kidney Injury on Incidence of 30-Day Readmissions among Hospitalized Veterans Affairs Patients with Skin and Skin Structure Infections.

Among hospitalized adults who received vancomycin for their skin and skin structure infection (SSSI), patients who experienced acute kidney injury (AKI) had considerably higher 30-day readmission rates. Nearly half of the observed 30-day readmissions were due to non-SSSI-related reasons, which is consistent with the persistent organ dysfunction observed among patients with AKI.

Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Knee Arthroplasty: A Review of 3015 Cases

BackgroundA higher volume of primary total knee arthroplasty (TKA) is starting to be performed in the outpatient setting. However, data on appropriate patient selection in the current literature are scarce. MethodsPatients who underwent primary TKA were identified in the 2012-2017 National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days. The primary outcome was a readmission within the 30-day postoperative period. Reasons for and timing of readmission were identified. Risk factors for and effect of overnight hospital stay on 30-day readmission were evaluated. ResultsA total of 3015 outpatient TKA patients were identified. The incidence of 30-day readmission was 2.59% (95% confidence interval [CI] 2.02-3.15). The majority of readmissions were nonsurgical site related (64%), which included thromboembolic and gastrointestinal complications. Risk factors for 30-day readmission include dependent functional status prior to surgery (relative risk [RR] 6.4, 95% CI 1.91-21.67, P = .003), hypertension (RR 2.5, 95% CI 1.47-4.25, P = .001), chronic obstructive pulmonary disease (RR 2.4, 95% CI 1.01-5.62, P = .047), and operative time ≥91 minutes (≥70th percentile) (RR 1.9, 95% CI 1.17-2.98, P = .008). For patients who had some of these risk factors, their rate of 30-day readmission was significantly reduced if they had stayed at least 1 night at the hospital. ConclusionOverall, the rate of 30-day readmission after outpatient TKA was low. Patients who are at high risk for 30-day readmission after outpatient TKA include those with dependent functional status, hypertension, chronic obstructive pulmonary disease, and prolonged operative time. These patients had reduced readmissions after overnight admission and seem to benefit from an inpatient hospital stay.

Predictors of Cost and Incidence of 30-Day Readmissions Following Hospitalizations for Schizophrenia and Psychotic Disorders: A Nationwide Analysis.

Schizophrenia and psychotic disorders (SPDs)-related hospitalizations are the second leading cause of 30-day readmission. This study assessed the effect of patient and hospital-level factors on readmission costs following index hospital discharges for SPDs. 2014 Nationwide Readmissions Database was used to identify SPD-related discharges between January 1, 2014, and November 30, 2014. Multivariable logistic regression was used to estimate patient and hospital-level predictors for readmissions. A two part model was used to estimate the predictors of readmission and associated cost for index hospital discharges with SPDs. A total of 77 625 of 343 579 (22%) index hospital discharges for SPDs resulted in readmissions. The average index and readmission costs were $9285 and $8593, respectively. Being 25 to 44 years old (odds ratio: 1.14), with nonmental comorbidities (odds ratio: 1.52), and admitted in private hospitals (odds ratio: 1.24) had significantly higher odds of readmission rates. Being males ($105), 25 to 44 years of age ($99), urban residents ($312), Medicare enrollees ($713 over privately insured), high-income area residents ($393), having multiple comorbidities ($923), and those admitted in large metropolitan ($680) and government-owned hospitals ($417) had higher costs of readmission. The high SPD-related readmission rates can be reduced by providing integrated behavioral health services for this high-risk cohort.

Abstract TMP73: Rehabilitation for Patients With Primary Intracerebral Hemorrhage is Associated With Reduced 30-Day Hospital Readmissions

Introduction: Readmission (RA) after stroke is an established quality of care metric and is tied to reimbursements. Administrative databases lack stroke-specific severity indicators and information on post-discharge mortality. We report the cumulative incidence of 30-day RA for patients with primary intracerebral hemorrhage (ICH) from a statewide prospective cohort. Methods: Eligible ICH patients are consented to participate in the cohort to assess the impact of level of care on patient-centered outcomes across Texas. Patients undergo inpatient evaluation, followed by 30- and 90-day assessments for functional, cognitive, quality of life, dependency, and resource utilization outcomes. We defined 30-day RA as any RA that was assessed 30 days post-acute care hospitalization for the index ICH event. We used survival analyses to provide hazard ratios (HR) and 95% confidence interval (CI), while modeling post-discharge mortality as a competing risk. Results: Thus far, 158 patients have been enrolled with RA information available for 104. The overall RA rate is 5.1 / 1000 person-days (CI: 3.1-8.3). Among the various factors evaluated (Table 1), 30-day RA is significantly higher for patients with a higher ICH score (HR: 5.67, CI: 1.45-22.19), whereas post-discharge rehabilitation (as compared to discharge to home) appears to reduce the risk of RA, even after accounting for institution-free period of observation (HR: 0.11, CI: 0.01-0.86). Among patients with a high ICH score, those discharged home had significantly higher risk of RA as compared to those who received rehabilitation (Figure 1). Enrollment is continuing; updated analyses will be presented. Conclusion: Stroke-specific disease severity factors are important to identify to develop effective preventive strategies against RA, and need to be controlled for when comparing RA metrics across patient populations. Influence of post-stroke rehab on curtailing RA for ICH patients needs to be explored further.

171 Psychiatric Comorbidities - What to Expect Post Spine Surgery

Abstract INTRODUCTION Improved life expectancy and elderly population has significantly increased the co-morbid conditions encountered by spine surgeons. One of the comorbidities include mood disorder patients requiring spine surgery. It is important to understand the short term outcome in these patients after spine surgery as it is known to impact the outcome. In this study, we detail outcomes for first 30days in patients with mood disorders. METHODS A retrospective database of 550 patients who underwent posterior lumbar spine surgery (between 2015 and 2016) was analyzed. We collected data including demographics, surgical technique, outcomes and complications. A multivariate regression analyses were performed assessing differences in outcomes and morbidity in the mood disorder (anxiety and depressive) versus non-mood disorder groups. RESULTS &gt;275 included patients were stratified into mood disorder (n = 24) and Non-mood disorder (n = 251) groups. The average age was 59.1 ± 14.6 years old with 48% patients being male. There was higher incidence of 30-day readmission in mood disorder group (12.5% vs 6%, P = 0.462). In regards to surgical outcome, patients with mood disorder tend to have higher mean VAS (4.5 vs 3.7, P = 0.089), higher mean ODI (24.2 vs 16.8, P &lt; 0.001), slightly lower mean EQ-50 (0.67 vs 0.77, P = 0.004) CONCLUSION Our study is provides detail estimate of short term outcome in patients with mood disorder. Our study patients operated at our institution and significantly differ from the online commercial database analysis. Spine surgeons also have to be aware of the outcomes and prepare to optimize the peri-operative condition. Patient education significantly reduces the expectation vs reality post spine surgery.

Incidence and risk factors of 30-day readmission in neurosurgical patients

AimThe 30-day readmission rate has become an important indicator of health care quality. This study focuses on the incidence of 30-day readmission in neurosurgical patients and related risk factors. Material and methodsA retrospective review was performed on patients treated in a neurosurgery department between 1 January 2012 and the 31 December 2013. Patients requiring readmission within 30 days of discharge and the readmission diagnosis were identified, and the factors related to their readmission were analysed. ResultsA total of 1854 interventions were carried out on 1739 patients during the aforementioned (study) period. Of the remaining patients, 174 (10.2%) required readmission within 30 days of discharge. The main causes of readmission were problems related to the surgical wound (21.2% of all readmissions), followed by respiratory processes (18.8%). A total of 73.9% of readmissions occurred in patients who had undergone cranial surgery. Multiple comorbidities estimated by Charlson comorbidity index and length of hospital stay were identified as factors related to a higher readmission rate. ConclusionsThe 30-day readmission rate observed in our series was 10.2%. Multiple comorbidity expressed by the Charlson comorbidity index and length of hospital stay were related to readmission.

Incidencia y factores de riesgo de reingreso hospitalario a los 30 días en pacientes neuroquirúrgicos

The 30-day readmission rate has become an important indicator of health care quality. This study focuses on the incidence of 30-day readmission in neurosurgical patients and related risk factors.A retrospective review was performed on patients treated in a neurosurgery department between 1 January 2012 and the 31 December 2013. Patients requiring readmission within 30 days of discharge and the readmission diagnosis were identified, and the factors related to their readmission were analysed.A total of 1,854 interventions were carried out on 1,739 patients during the aforementioned (study) period. Of the remaining patients, 174 (10.2%) required readmission within 30 days of discharge. The main causes of readmission were problems related to the surgical wound (21.2% of all readmissions), followed by respiratory processes (18.8%). A total of 73.9% of readmissions occurred in patients who had undergone cranial surgery. Multiple comorbidities estimated by Charlson comorbidity index and length of hospital stay were identified as factors related to a higher readmission rate.The 30-day readmission rate observed in our series was 10.2%. Multiple comorbidity expressed by the Charlson comorbidity index and length of hospital stay were related to readmission.

Contributions of planned readmissions and patient comorbidities to high readmission rates in vascular surgery patients

Administrative data show that among surgical patients, readmission rates are highest in vascular surgery. Herein we analyze the contribution of planned readmissions and patient comorbidities to high readmission rates in vascular surgery. The 2012 to 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set was analyzed for overall and unplanned readmissions. Bivariable and multivariable risk adjustment analyses were performed using patient comorbidities to compare risks of overall and unplanned readmissions in vascular surgery compared with other specialties. Among 1,164,421 surgical patients, 86,403 underwent a vascular operation (other specialties included general surgery, 587,829 [51%]; orthopedic surgery, 211,507 [18%]; gynecology, 82,771 [7%]; urology, 62,153 [5%]; neurosurgery, 55,030 [4.7%]; plastic surgery, 32,318 [3%]; otolaryngology, 31,070 [2.6%]; and thoracic surgery, 15,340 [1%]). Incidence of 30-day readmission was 10.2% for vascular and 5.5% for other specialties (P < .0001). Planned readmissions were more frequent for vascular than for other specialties (8.8% vs 5.4%; P < .0001). In unadjusted analysis, vascular patients had significantly greater risk for overall readmission (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.93-2.02; P < .0001) and unplanned readmission (OR, 1.89; 95% CI, 1.84-1.93; P < .0001) compared with other specialties. In bivariable analysis, vascular patients were older (67 ± 13 vs 56 ± 17 years) and had more comorbidities such as diabetes (31% vs 14%), dialysis dependence (6.3% vs 0.9%), American Society of Anesthesiology class III/IV status (84% vs 41%), and many others (all P < .0001). After risk adjustment for baseline differences between groups, vascular patients had a marginally greater overall risk of readmission compared with other specialties (OR, 1.04; 95% CI, 1.01-1.07; P < .0001), but the risk of unplanned readmission was not significantly different (OR, 0.98; 95% CI, 0.95-1.01; P = .13). Incidence of 30-day readmission after vascular surgery appears high, but after account for planned readmissions and risk adjustment, the risk of unplanned readmission is similar to that in other surgical patients. Thus, the use of readmission rate as a quality measure must account for more frequent planned vascular readmissions and patient-specific differences between vascular surgery and other specialties.

Homeward Bound: The Safety of Discharging Postappendectomy Patients Directly Home from the Recovery Room

The discharge of the patients directly from the recovery room after appendectomy has only recently been described in the literature. Because the 30-day readmission rate is used as a surrogate for safety and as a means to identify complications from appendicitis, it is our aim to demonstrate that the 30-day readmission rate of patients with acute appendicitis discharged from the recovery room is not higher than that of a control group and that from other studies in the literature for traditional hospital discharge. The operating room electronic database at Kaiser Riverside and Kaiser Moreno Valley hospitals was used to identify all appendectomies from September 1, 2008, to April 30, 2013. During that span, 2044 appendectomies were performed. Eight hundred seventy (43%) were discharged from the recovery room. Of these patients, 861 (99%) had a laparoscopic appendectomy. The average time from anesthesia end time until discharge from the recovery room was 2 hours 42 minutes. There were 12 (1.4%) total readmissions with nine (1%) related to previous appendectomy compared with one (0.9%) in the control group. None of the readmissions were the result of early life-threatening problems such as bleeding, bowel injury, intraperitoneal bladder injury, or stump leak. Patients with acute appendicitis who were discharged home from the recovery room did not have an increased incidence of 30-day readmission when compared with traditional hospital discharge.

Enhanced recovery pathways lead to an improvement in postoperative outcomes following esophagectomy: systematic review and pooled analysis

The aim of this systematic review and pooled analysis is to determine the effect of enhanced recovery programs (ERP) on clinical outcome measures following esophagectomy. Medline, Embase, trial registries, conference proceedings, and reference lists were searched for trials comparing clinical outcome from esophagectomy followed by a conventional pathway with esophagectomy followed by an ERP. Primary outcomes were the incidence of postoperative mortality, anastomotic leak and pulmonary complications, and secondary outcomes were length of hospital stay and the incidence of 30-day readmission. Nine studies were included comprising 1240 patients, 661 patients underwent esophagectomy followed conventional pathway, and 579 patients underwent ERP. Utilization of ERP was associated with a reduction in the incidence of anastomotic leak (12.2-8.3%; pooled odds ratios = 0.61; 95% confidence interval = 0.39 to 0.96; P = 0.03) and pulmonary complications (29.1-19.6%; pooled odds ratios = 0.52; 95% confidence interval = 0.36 to 0.77; P = 0.001) and length of hospital stay, and no significant change in postoperative mortality or readmission rate. There was significant variation in the design of enhanced recovery protocols, surgical approach, and utilization of neoadjuvant therapies between the studies that are important confounding variables to be considered. This study suggests a benefit to the utilization of ERP following esophagectomy. The pathways provide a template for all medical personnel interacting with these patients in order to provide incremental changes in all aspects of clinical care that translates into global improvements seen in postoperative outcomes.