Hospital Readmissions after Surgery: How Important Are Hospital and Specialty Factors? - 19/04/17

Doi : 10.1016/j.jamcollsurg.2016.12.034

Robert H. Hollis, MD, MSPH ^a,^b, Laura A. Graham, MPH ^a,^b, Joshua S. Richman, MD, PhD ^a,^b, Melanie S. Morris, MD, FACS ^a,^b, Hillary J. Mull, PhD ^c,^d, Tyler S. Wahl, MD ^a,^b, Edith Burns, MD ^g, Laurel A. Copeland, PhD ^f,^i,^j, Gordon L. Telford, MD, FACS ^g,^h, Amy K. Rosen, PhD ^c,^d, Kamal F. Itani, MD, FACS ^c,^d,^e, Jeffrey Whittle, MD, MPH ^g, Todd H. Wagner, PhD ^k,^l, Mary T. Hawn, MD, MPH, FACS ^k,^l,^⁎
^a Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL
^b Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
^c Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA
^d Department of Surgery, Boston University School of Medicine, Boston, MA
^e Harvard University School of Medicine, Boston, MA
^f Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA
^g Milwaukee Veterans Affairs Medical Center, Milwaukee, WI
^h Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
ⁱ Baylor Scott & White Health, Center for Applied Health Research, Temple, TX
^j Texas A&M Health Science Center, College of Medicine, Temple, TX
^k Veterans Affairs, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA
^l Department of Surgery, Stanford University School of Medicine, Palo Alto, CA

^∗Correspondence address: Mary T Hawn, MD, MPH, FACS, Department of Surgery, Stanford University, 300 Pasteur Dr, M121 Always Building, Stanford, CA 94305.Department of SurgeryStanford University300 Pasteur DrM121 Always BuildingStanfordCA94305

Abstract

Background

Hospital readmission rates after surgery can represent an overall hospital effect or a combination of specialty and patient effects. We hypothesized that hospital readmission rates for procedures within specialties were more strongly correlated than rates across specialties within the same hospital.

Study Design

For general, orthopaedic, and vascular specialties at Veterans Affairs hospitals during 2008 to 2014, 30-day risk-adjusted readmission rates were estimated for 6 high-volume procedures and each specialty. Relationships were assessed using the Pearson correlation coefficient.

Results

At 84 hospitals, 64,724 orthopaedic, 24,963 general, and 10,399 vascular inpatient procedures were performed; mean readmission rates were 6.3%, 13.6%, and 16.4%, respectively. There was no correlation between specialty-specific adjusted hospital readmission rates: general and orthopaedic (r = 0.21; p = 0.06), general and vascular (r = 0.15; p = 0.19), and vascular and orthopaedic surgery (r = 0.07; p = 0.55). Within specialties, we found modest correlations between knee and hip arthroplasty readmission rates (r = 0.39; p < 0.01) and colectomy and ventral hernia repair (r = 0.24; p = 0.03), but not between lower-extremity bypass and endovascular aortic repair (r = 0.13; p = 0.26). Overall, controlling for patient-level factors, 1.9% of the variation in readmissions was attributable to specialty-level factors; only 0.6% was attributable to hospital-level factors.

Conclusions

Hospital readmission rates for orthopaedic, vascular, and general surgery were not correlated between specialties; within each of the 3 specialties, modest correlations were found between 2 procedures within 2 of these specialties. These findings suggest that hospital surgical readmission rates are primarily explained by patient- and procedure-specific factors and less by broader specialty and/or hospital effects.

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Plan

Methods

Study population and data sources

	Disclosure Information: Nothing to disclose.
	Support: This study was supported by a Veterans Affairs Health Services Research and Development Grant (#IIR 12-358). Dr Hollis was supported by grant T32 CA091078-13 from the NIH. Dr Wahl was supported by the AHRQ grant T32 HS013852-11.
	Disclaimer: The opinions expressed are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs of the United States Government. The sponsors had no role in formation of the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.