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Original Investigation | Pacific Coast Surgical Association

Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery

Lisa K. McIntyre, MD1,2; Saman Arbabi, MD1,2; Ellen F. Robinson, PT3; Ronald V. Maier, MD1,2
[+] Author Affiliations
1Department of Surgery, University of Washington Medical Center, Seattle
2Division of Trauma and Burn Surgery, Harborview Medical Center, Seattle, Washington
3Department of Quality Improvement, Harborview Medical Center, Seattle, Washington
JAMA Surg. 2016;151(9):855-861. doi:10.1001/jamasurg.2016.1258.
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Importance  Previous studies investigating patients at risk for hospital readmissions focus on medical services and have found chronic conditions as contributors. Little is known, however, of the characteristics of patients readmitted from surgical services.

Objective  Surgical patients readmitted within 30 days following discharge were analyzed to identify opportunities for intervention in a cohort that may differ from the medical population.

Design, Setting, and Participants  Medical record review of patients readmitted to any service within 30 days of discharge from the general surgery service to characterize index and readmission data between July 1, 2014, and June 30, 2015, at a Level I trauma center and safety-net hospital.

Main Outcomes and Measures  Reasons for readmission identified by manual medical record review and risk factors identified via statistical analysis of all discharges during this period.

Results  One hundred seventy-three patients were identified as being unplanned readmissions within 30 days among 2100 discharges (8.2%). Of these 173 patients, 91 were men. Common reasons for readmission included 29 patients with injection drug use who were readmitted with soft tissue infections at new sites (16.8% of readmissions), 25 with disposition support issues (14.5%), 23 with infections not detectable during index admission (13.3%), and 16 with sequelae of their injury or condition (9.2%). Sixteen patients were identified as having a likely preventable complication of care (9.2%), and 2 were readmitted owing to deterioration of medical conditions (1.2%). On univariate and multivariate analyses, female sex (men to women risk of readmission odds ratio [OR], 0.5; 95% CI, 0.37-0.71; P < .001), presence of diabetes (OR, 1.7; 95% CI, 1.1-2.6; P = .009), sepsis on admission (OR, 1.7; 95% CI, 1.05-2.6; P = .03), or intensive care unit stay during index admission (OR, 1.7; 95% CI, 1.2-2.4; P = .002), as well as discharge to respite care (OR, 2.3; 95% CI, 1.2-4.5; P = .01) and payer status (Medicaid/Medicare compared with commercial OR, 2.0; 95% CI, 1.3-3.0; P = .002) , were identified as risk factors for readmission.

Conclusions and Relevance  Many readmissions may be unavoidable in our current paradigms of care. While medical comorbidities are contributory, a large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions but by confounding issues of substance abuse or homelessness. Identification of the highest risk cohort for readmission can allow more targeted intervention for similar populations with socially challenged patients.

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