Reasons For Readmission Research Articles

Rate and Causes of Unplanned Hospital Returns within 60 Days following Head and Neck Surgery.

Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score ( p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost.

Background: Bundled payments for total joint arthroplasty (TJA) were instituted by the Centers for Medicare and Medicaid Services (CMS) to reimburse providers a lump sum for operative and 90-day postoperative costs. Gaining a better understanding of which TJA patients are at risk for early return to the operating room (OR) is critical in preoperative optimization of those with modifiable risks, which could improve bundled-payment performance. Purpose: We sought to identify the most common reason for readmissions, as well as patient characteristics and costs, associated with early return to the OR among TJA patients. Methods: This was a retrospective cohort study of Medicare patients who had undergone primary total hip or knee arthroplasty (THA or TKA) between 2013 and 2018 at a tertiary care hospital. We used the CMS research identifiable files database to identify the most common reasons for readmissions and revisions within 90 days of surgery. Total billing claims were used to determine the cost of early readmissions and revisions. Multivariate regression analysis was used to determine the characteristics associated with early readmission or revision. Results: Out of 20 166 primary TJA patients identified, we found 1349 readmissions (5.6%) and 163 (0.8%) revisions within 90 days of surgery. Dislocation was the most common indication for readmission, and periprosthetic joint infection was the most common indication for revision. Early return to the OR was associated with a mean $105,988 (standard deviation [SD] = $76,865) in CMS claims for the inpatient stay. Factors associated with a higher risk of early reoperation were female sex, THA, longer length of stay, and discharge to long-term care facility. Conclusions: This retrospective cohort study found that early return to the OR after TJA increased overall 90-day costs by 260%, suggesting that early reoperation might have a significant impact on bundled payments. Further study is warranted.

Perioperative quality indicators among neurosurgery patients: A retrospective cohort study of 1142 cases at a tertiary center.

The purpose of this study was to present the first comprehensive analysis of perioperative quality indicators; length of hospital stay; readmission; reoperation; pre-, intra, and postoperative events; and mortality in a diverse neurosurgical patient cohort in Europe. Electronic medical records of all patients who were admitted to our institution between January 1 and December 31 of 2020, and underwent an index neurosurgical operation (n = 1142) were retrospectively reviewed. The median length of hospital stay at the index admission and readmission was 8 days (range: 1-242 days) and 5 days (range: 0-94 days), respectively. Of the 1142 patients, 22.9% (n = 262) had an extended length of hospital stay of ≥14 days. The all-cause 7-, 15-, 30-, 60-, and 90-day readmission rates were 3.9% (n = 44), 5.7% (n = 65), 8.8% (n = 100), 12.3% (n = 141), and 16.5% (n = 188), respectively. The main reason for unplanned readmission was deterioration of medical and/or neurological condition. The all-cause 7-, 15-, 30-, 60-, and 90-day reoperation rates were 11.1% (n = 127), 13.8% (n = 158), 16.5% (n = 189), 18.7% (n = 213), and 19.4% (n = 221), respectively. Unplanned reoperations were due primarily to hydrocephalus. The rate of preoperative events was 1.1% (n = 13), one-third of which were associated with infection. The rate of intraoperative events was 11.0% (n = 126), of which 98 (64.47%) were surgical, 37 (24.34%) were anesthesiologic, and 17 (11.18%) were associated with technical equipment. The rate of postoperative events was 9.5% (n = 109). The most common postoperative event was malfunction, disconnection, or dislocation of an implanted device (n = 24, 17.91%). The mortality rates within 7, 15, 30, 60, and 90 days after the index operation were 0.9% (n = 10), 1.8% (n = 21), 2.5% (n = 29), 3.4% (n = 39), and 4.7% (n = 54), respectively. Several patient characteristics and perioperative factors were significantly associated with outcome parameters. This study provides an in-depth analysis of quality indicators in neurosurgery, highlighting a variety of inherent and modifiable factors influencing patient outcomes.

Unplanned 30-day readmission rate after ophthalmological surgery as a quality-of-care indicator.

The 30-day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30-day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission. All patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity. For the 8522 ophthalmic surgeries performed in the four-year study period, 282 30-day unplanned readmissions were identified. The overall 30-day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non-elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30-day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30-day readmissions were not associated with an ophthalmological problem. This study is the first to report 30-day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals.

Abstract WMP59: Prognosis After Cerebral Venous Thrombosis: Long-Term Readmission Patterns in a Canadian Population-Based Cohort

Background: Information on long-term care utilization patterns following the acute care period of cerebral venous thrombosis (CVT) is limited. We examined readmission reasons and patterns after discharge from index CVT hospitalization. Methods: A population-based cohort of patients diagnosed with CVT (2000-2017) was constructed using linked administrative data. Descriptive statistics were calculated for baseline demographics and readmission causes. Readmission proportions were calculated for first readmission every year during the 10 years after diagnosis. Survival analysis was used to examine associations between patient factors and readmission events. Results: The cohort included 508 patients, 56% female and mean age 49.6 years (SD 19). Median time-to-first readmission is 1.8 years (95% CI 1.4-2.4), with 39% of patients readmitted in 1 year (95% CI 35-43) and 69% in 5 years (95% CI 64-73). Cancer-related CVT was associated with a higher rate of readmission (p<0.0001) and traumatic CVT was associated with a lower rate (p=0.005). In patients younger than age 50 (mean: 36.1 years, SD 9), headache and epilepsy were among the top five reasons for readmission. For patients older than 50 years (mean: 67.6 years, SD 11), cerebral infarction was among the top five reasons. Readmission rate stabilized over time. Conclusion: Cancer-related CVT was associated with significantly higher readmissions and traumatic CVT had significantly lower readmissions. The most common neurologic reasons for readmission differed by age group, but included headaches, seizures, and stroke. Readmission rates were highest in the first two years following discharge but stabilized over time.

Readmission after thoracic endovascular aortic repair following blunt thoracic aortic injury.

Thoracic endovascular aortic repair (TEVAR) is increasingly utilized to treat blunt thoracic aortic injury (BTAI), but post-discharge outcomes remain underexplored. We examined 90-day readmission in patients treated with TEVAR following BTAI. Adult patients discharged alive after TEVAR for BTAI in the Nationwide Readmissions Database between 2016 and 2019 were included. Outcomes examined were 90-day non-elective readmission, primary readmission reasons, and 90-day mortality. As a complementary analysis, 90-day outcomes following TEVAR for BTAI were compared with those following TEVAR for acute type B aortic dissection (TBAD). We identified 2085 patients who underwent TEVAR for BTAI. The median age was 43years (IQR, 29-58), 65% of all patients had an ISS ≥ 25, and 13% were readmitted within 90days. The main primary causes for readmission were sepsis (8.8%), wound complications (6.7%), and neurological complications (6.5%). Two patients developed graft thrombosis as primary readmission reasons. Compared with acute TBAD patients, BTAI patients had a significantly lower rate of readmission within 90days (BTAI vs. TBAD; 13% vs. 29%; p < .001). We found a significant proportion of readmission in patients treated with TEVAR for BTAI. However, the 90-day readmission rate after TEVAR for BTAI was significantly lower compared with acute TBAD, and the common cause for readmission was not related to residual aortic disease or vascular devices. This represents an important distinction from other patient populations treated with TEVAR for acute vascular conditions. Elucidating differences between trauma-related TEVAR readmissions and non-traumatic indications better informs both the clinician and patients of expected post-discharge course. Level of evidence/study type: IV, Therapeutic/care management.

Nurses' perspectives on the provision of self-care management education to patients with heart failure: A qualitative study at Cardiac Hospital, Dar es Salaam Tanzania.

Patients' education along with a motivation for developing self-care management skills is an essential component in the management of heart failure(HF). Self-care management education has been practiced by nurses in many hospitals. However, there is inadequate evidence for the provision of self-care management education in low-income countries including Tanzania. Lack of self-care management education to patients with HF during discharge is the most common reason for re-admission to hospitals. This study aimed to explore nurses' perspectives focusing on facilitators and barriers to the provision of self-care management education to patients with heart failure at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania. This study used a qualitative descriptive design. Purposive sampling was used to recruit 12 study participants. In-depth interviews were used to collect the data. We used thematic analysis to come up with the themes and sub-themes. The two major themes emerged from this study; The first theme is "Improved patient quality of life and health outcome" which describes factors that motivate nurses to continue giving self-care management education to heart failure patients. The second theme is "Reduced effective uptake of self-care management education" which describes nurses'perspectives on barriers for providing self-care management education to heart falure patients. Nurses highlight some barriers while providing self-care management education to patients with heart failure including;inadequate knowledge of self-care management among nurses, lack of privacy during the provision of self-care education, poor communication skills among nurses, and lack of learning materials. Also, nurses pointed out facilitators that influence the provision of self-care management education such as increased involvement of family members and the use of peer educators. Poor self-care management for patients with heart failure results in readmission and prolonged hospital stay. Family involvement and the use of peer educators are the key steps in the improvement of self-care management for patients with HF. However, patient cognitive impairment and poverty which contribute to poor health outcomes, should be taken into consideration when planning for discharge for patients with HF. Self-care management education should be part of routine health care.

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes. To identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC. This retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023. TORS for OPSCC. Univariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined. A weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]). In this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.

Heart Failure Readmissions: A Deep Dive into Patient Demographics, Comorbidities, and Systemic Challenges

Background: Heart failure (HF) is a leading cause of hospital readmissions, presenting significant challenges in healthcare. Comorbid conditions like diabetes and hypertension are prevalent among HF patients and may complicate disease management. Understanding these dynamics is crucial for developing effective intervention strategies. Objective: This study aims to analyze the factors contributing to HF readmissions, focusing on patient demographics, comorbidities, and systemic healthcare challenges. Methods: A comprehensive, retrospective cohort analysis was conducted at a tertiary care cardiac center. The study included 1,000 patients with a documented history of HF and instances of hospital readmissions. Patient selection was based on age (≥18 years), a diagnosis of HF, and readmission within six months post-discharge. Exclusion criteria included planned readmissions for elective procedures and cognitive impairments impeding consent. Data collection encompassed patient demographics, clinical history, comorbidity details, initial hospitalization, and readmission information. Descriptive statistics were employed to analyze and summarize the data. Results: The cohort comprised 80% male (n=800) and 20% female (n=200) with a mean age of 58 years. The median hospital stay was 6 days. Comorbidities included diabetes (78%, n=780) and hypertension (56%, n=560). The primary cause of HF was ischemic cardiomyopathy (82%, n=820). The leading reasons for readmission were lack of counseling (42%, n=420), underdosage of medication (16%, n=160), and non-compliance to medication (13%, n=130). Other factors included volume overload (11%, n=110), secondary hypertensive failure (9%, n=90), infections (6%, n=60), anemia (2%, n=20), and progressive renal failure (1%, n=10). Conclusion: The study highlights the complexity of managing HF, emphasizing the need for comprehensive approaches addressing patient education, medication management, and comorbidity control. Improved patient counseling and adherence to treatment regimens could significantly reduce HF readmissions.

Predictors of early and long-term readmissions and their association with survival after liver transplantation

BackgroundThe impact of post liver transplantation (LT) readmissions on mortality has not been well described. Thus, the primary objective of our study was to determine predictors of readmissions post-LT and assess impact on survival. MethodsSingle center retrospective observational study investigating adult patients who underwent LT between January 1, 2010 – December 31, 2019 at Toronto General Hospital (TGH). Time-dependent cox regression model was used to investigate risk factors for 30-day, 30–90-day, and >90-day readmissions to hospital. The effect of readmission on survival was assessed with the Kaplan–Meier estimator. Results987 patients fulfilled inclusion criteria. Significant predictors of 30-day readmissions were BMI > 30 kg/m2 (HR=0.64; CI 0.42–0.98; p-value 0.04) and autoimmune/cholestatic liver disease (HR=1.86; CI 1.01–3.42; p = 0.046) at 30-days. Post-LT length of stay (HR=1.05; CI 1.02–1.08; p<0.001) at 30–90 days. Meanwhile, living donor LT (HR=1.41; CI 1.06–1.89; p = 0.02) and distance from LT center (HR=1.05; CI 1.01–1.09; p = 0.011) after 90 days. Infection was the main reason for readmission across three time periods. An inpatient readmission across any time period was found to be significantly associated with mortality (HR=2.4; 1.6–3.6; p<0.0001). ConclusionHospital readmissions post-LT are associated with increased mortality. Although infection is a common risk factor for readmission other modifiable risk factors may be an area for target of interventions to reduce post-LT readmission.

Age-related outcomes after pediatric branchial cleft cyst excision via NSQIP-P

ObjectiveBranchial cleft cysts present at varying ages; sometimes excision is delayed because of concern about operating in small children. Our goal was to determine if outcomes and complications differed among pediatric age groups. Study designRetrospective, cross-sectional. SettingAmerican College of Surgeons’ National Surgical Quality Improvement Pediatric database. MethodsPatients who underwent a branchial cleft cyst excision between 2016 and 2020 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Pediatric database. Patients with CPT code 42,815: ‘excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx’ as their primary procedure were included. Variables of interest included patient demographics, comorbidities, pre-operative risk factors and complications. Results2267 patients with median age of 3.9 (IQR: 7.4, range: 0.04–17.9) years were included. The most common pre-operative risk factors were 149 (7 %) patients with prematurity, 136 (6 %) with developmental delay, 135 (6 %) with congenital malformation, and 128 (6 %) with open wound or wound infection. 68 (3 %) patients experienced at least one post-operative complication, with 73 post-operative complications documented in total. Surgical site infections were the most common complications with 49 (67.1 %) superficial infections, 11 (15.1 %) deep infections, and 4 (5.5 %) organ/space infections. Surgical site infections were the most common reason for related readmission. Duration of anesthesia and operative time increased significantly as patient age increased (p < .001 for both). There was no significant correlation between age and complication incidence. ConclusionBranchial cleft cyst excision is a relatively safe operation with a low complication rate, even in young pediatric populations.

Risk factors for unplanned readmissions in paediatric neurosurgery: a systematic review protocol

IntroductionUnplanned hospital readmission (UHR) following surgical procedures reflects patient outcomes. While adult readmission studies are abundant, limited research exists in paediatric populations, especially in the context of neurosurgery.Methods and analysisThis...

Same-day discharge after craniotomy for tumor resection: a retrospective observational single-center study of 630 patients.

Modern neurosurgical developments enable minimally invasive surgery with shorter operation times, faster recovery, and earlier hospital discharge. These in combination with Enhanced Recovery After Surgery (ERAS) protocols have the potential to safely shift craniotomy for tumor resection to the ambulatory setting in selected patients. The aim of this retrospective observational single-center study was to assess the success rate of planned same-day discharge from hospital in patients undergoing craniotomy for supratentorial brain tumor resection under general anesthesia or awake craniotomy as well as to explore potential associations with anesthesia techniques, complications, and readmission rates. A retrospective analysis of all patients scheduled for same-day discharge after supratentorial craniotomy for tumor resection over 25 years (1996-2021) was performed. Patients were identified for same-day discharge based on specific inclusion and exclusion criteria. Data collected included patient demographics, comorbidities, anesthetic data, perioperative complications, and patient dispositions. Data are presented descriptively. A total of 630 patients (mean age 50.9 years; 311 females, 319 males) scheduled for same-day discharge were analyzed. Patients underwent either awake craniotomy (AC; n = 491) or craniotomy under general anesthesia (GA; n = 139). Successful preplanned same-day discharge occurred in 571 (90.6%). Failed same-day discharge happened in 59 patients (GA, n = 14; AC, n = 45). Reasons for failed discharge included the following: new neurological deficit (n = 28); presence of seizure (n = 8); postoperative nausea and vomiting (PONV; n = 12); excessive headache (n = 5); and/or social factors (n = 10). Nine patients (1.4%) (GA, n = 0; AC, n = 9) with same-day discharge required readmission to hospital within the first 24 hours after discharge. Reasons for readmission included headache (n = 2), seizure (n = 4), neurological deficit (n = 3), and/or PONV (n = 1); all patients were successfully discharged from hospital after 1 day with no need for reoperation. This retrospective, single-center analysis shows that same-day discharge after craniotomy can be safe in carefully selected patients after both GA and AC for tumor resection. Multidisciplinary involvement (surgeons, anesthesiologists, nurses, and other allied health professionals) optimizes success of same-day craniotomy programs. Future optimization of analgesia and prevention of PONV has the potential to increase the success rate.

Knowing the Patient: Understanding Readmission Reasons in Complex Heart Failure.

Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

Discharge Against Medical Advice From Emergency Department of Sina Hospital: A Cross-sectional Study of the Involved Causes and Factors

Background: Discharge against medical advice (DAMA) is a significant issue that causes problems for the patient and the hospital. It is possible to improve healthcare quality by examining the causes and factors affecting DAMA. The present study investigated the causes of DAMA in the emergency department of Sina Hospital. Methods: This cross-sectional study was conducted in the emergency department of Sina Hospital in Hamedan. The research population included 125 patients. A valid checklist was used to collect data. The information collected by the checklist included demographics, information related to hospitalization, and reasons for DAMA and re-admission of the patient after 15 days. Finally, the data were analyzed using SPSS version 24 statistical software. Results: In this study, 125 DAMA patients were investigated, including 86 males with an average age of 30.48 years and an average length of hospitalization of 6.12 hours. Most of the patients were between 31 and 50 years old (70.4%) and married (62.2%). Furthermore, most of them were hospitalized (51.2%) or discharged (47.2%) during the night shift. The main reason for DAMA was the reasons related to the patient (60.8%), and the reasons related to the hospital staff (22.4%) and the condition of the hospital (16.8%) were in the next ranks. The main reasons related to the patient were the feeling of enough recovery, the desire to continue treatment at home (35.5%), and the desire to visit private centers (18.4%). Conclusion: Given that the majority of discharge cases were related to patient-related issues, it is possible to reduce the rate of discharge against medical advice by using techniques such as informing patients about the treatment process, the problems of early discharge, equipping the hospital with diagnostic-therapeutic means, and controlling the quality of medical services.

Impact of unplanned readmissions on lumbar surgery outcomes: a national study of 33,447 patients

Background ContextUnplanned readmissions following lumbar spine surgery have immense clinical and financial implications. However, little is known regarding the impact of unplanned readmissions on patient-reported outcomes (PROs) following lumbar spine surgery. PurposeTo evaluate the impact of unplanned readmissions, including specific readmission reasons, on patient reported outcomes 12 months after lumbar spine surgery. Study Design/SettingA retrospective cohort study of prospectively collected data was conducted using patients included in the lumbar module of the Quality and Outcomes Database (QOD), a national, multicenter spine registry. Patient SampleA total of 33,447 patients who underwent elective lumbar spine surgery for degenerative diseases were included. Mean age was 59.8 (SD=14.04), 53.6% were male, 89.5% were white, 45.9% were employed, and 47.5% had private insurance. Outcome MeasuresUnplanned 90-day readmissions and 12-month patient-reported outcomes (PROs) including numeric rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, EuroQol-5 Dimension (EQ-5D) scores, and North American Spine Society (NASS) patient-satisfaction scores. MethodsThe lumbar module of the QOD was queried for adults undergoing elective lumbar spine surgery for degenerative disease. Unplanned 90-day readmissions were classified into 4 groups: medical, surgical, pain-only, and no readmissions. Medical and surgical readmissions were further categorized into primary reason for readmission. 12-month PROs assessing patient back and leg pain (NRS), disability (ODI), quality of life (EQ-5D), and patient satisfaction were collected. Multivariable models predicting 12-month PROs were built controlling for covariates. ResultsA total of 31,430 patients (94%) had no unplanned readmission while 2,017 patients (6%) had an unplanned readmission within 90 days following lumbar surgery. Patients with readmissions had significantly worse 12-month PROs compared with those with no unplanned readmissions in covariate-adjusted models. Using Wald-df as a measure of predictor importance, surgical readmissions were associated with the worst 12-month outcomes, followed by pain-only, then medical readmissions. In separate covariate adjusted models, we found that readmissions for pain, SSI/wound dehiscence, and revisions were among the most important predictors of worse outcomes at 12-months. ConclusionsUnplanned 90-day readmissions were associated with worse pain, disability, quality of life, and greater dissatisfaction at 12-months, with surgical readmissions having the greatest impact, followed by pain-only readmissions, then medical readmissions. Readmissions for pain, SSI/wound dehiscence, and revisions were the most important predictors of worse outcomes. These results may help providers better understand the factors that impact outcomes following lumbar spine surgery and promote improved patient counseling and perioperative management.

A short length of hospital stay is not associated with risk of readmission among hip fracture patients – a Swedish national register-based cohort study

BackgroundHospital length of stay (LoS) after a hip fracture likely mirrors health status; however, a too short hospitalization might increase the risk of readmission. In this national register-based study, we investigated the association between LoS after a hip fracture and the risk of readmissions.Methods73,551 patients with a first hip fracture between 2012 and 2019 were followed for 4 months after discharge. LoS was categorized by cubic splines and the association with readmissions was analyzed with Cox regression models.ResultsThe mean LoS was 11 ± 6 days and 25% of the study population had at least one readmission. Compared to the mean LoS of 9–12 days, there was a 18% decreased risk of readmission for LoS of 2–4 days (HR 0.82 [95% CI 0.77–0.87]) and 13% decrease for 5–8 days (HR 0.87 [95% CI 0.83–0.91]), when adjusting for sex, age, walking ability, ASA score, CCI, complications during hospitalization and living arrangements. For longer LoS, risk of readmission increased (13–23 days: HR 1.09 [95% CI 1.05–1.13] and 24 + days: HR 1.19 [95% CI 1.11–1.28]). The results were robust across sex, age, and living arrangements. The most common specific reasons for readmission were trauma/injury, cardiovascular and complications, and the proportions did not differ considerably between short and long LoS-categories.ConclusionsWhile a long LoS can be explained by the care need of the patient, a short LoS - compared to the average stay - does not increase the risk of readmission regardless of health status and hospital complications in a Swedish setting.

Assessment of Patient Satisfaction and Outcomes After Outpatient Joint Arthroplasty in Academic Medical Centers

BackgroundThere is limited literature evaluating patient satisfaction and outcomes after outpatient joint arthroplasty procedures in academic medical centers (AMCs). The aims of this study are to determine: (1) patients' desires to repeat their procedures and be discharged on the same day, (2) patient-reported outcome measures (PROMs), (3) time to discharge, (4) readmission rates, and (5) factors that predict PROMs in patients undergoing outpatient joint arthroplasty in AMCs. MethodsA prospective survey was completed by 66 total hip arthroplasty (THA), 35 total knee arthroplasty (TKA), and 180 unicondylar knee arthroplasty (UKA) outpatients who underwent surgery from May 2018 to December 2020 in 2 AMCs. The survey consisted of questions regarding hip or knee PROMs (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement), satisfaction with outpatient procedures and discharges, and reasons for readmissions. Linear regression analysis was conducted with statistical significance set at P < .05. Results100% of THA, 93.8% of TKA, and 93.0% of UKA outpatients stated that they would re-elect to undergo their respective procedure. Furthermore, 94% of THA, 81% of TKA, and 95% of UKA patients stated they would like same-day discharge again. THA, TKA, and UKA patients reported respective mean PROM scores of 94.7, 89.9, and 86.1. Readmission rates were 1.5%, 0.0%, and 0.5%, for THA, TKA, and UKA, respectively. ConclusionsPatients who underwent outpatient joint arthroplasty procedures at 2 AMCs experienced minimal readmissions and reported a high desire to repeat their outpatient procedures.

Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation.

Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.

Abstract 17240: Preoperative Pectoralis Muscle Area Index is Associated With Increased Post-LVAD Length of Stay and 90-day Readmission

Background: In LVAD pts, preoperative sarcopenia, as measured by pectoralis muscle area index (PMI), has been associated with mortality and GI bleed; however, the association with length of stay (LOS) and readmission is unknown. Methods: This was a single-center retrospective cohort study of pts who underwent LVAD 01/2015-10/2018. Preoperative pectoralis muscle area was measured on CT chest prior to implant using Tera Recon, adjusted for height squared to give the PMI. Multivariable negative binomial regressions were used to assess the association between PMI and LOS. Subhazard ratios (SHR) and cause-specific hazard ratios (CSHR) were used to assess the association between PMI and freedom from 90-day readmission. Results: Of 254 LVAD pts, 95 had a preop CT chest and were included (median days CT to LVAD: 7 [IQR 3-13]). Pts with PMI in the lowest quartile (PMI &lt; 4.86 cm 2 /m 2 ) constituted the low PMI cohort; all others served as the reference cohort. Baseline characteristics are shown in the Table. During index hospitalization, 2 low PMI pts died vs 7 reference; 0 low PMI pts were transplanted vs 2 reference. Low PMI was associated with longer post-LVAD LOS (adjusted incidence rate ratio 1.31 [95% CI 1.03-1.66], p =0.03) and increased risk of 90-day readmission (aSHR, accounting for risk of death and transplantation, 3.77 [1.17-12.1], p =0.03; aCSHR 3.67 [1.35-9.96], p =0.01) (Fig). The most common reason for readmission in low PMI pts was infection (n=3). Conclusions: Low PMI is associated with longer LOS and higher likelihood of 90-day readmission after LVAD. PMI could be used to identify sicker patients at risk for more intensive medical intervention and potentially higher health care cost.