Variation in Surgical Readmissions and Relationship to Quality of Hospital Care

By T. Tsai, Karen E. Joynt, E. Orav, A. Gawande, A. Jha. New England Journal of Medicine, 2013

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Background Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Methods Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. Results There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Conclusion Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals.

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology, Pulmonary and Respiratory Medicine

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