RT Journal
A1 Kazaure HS, Roman SA, Sosa JA
T1 ASsociation of postdischarge complications with reoperation and mortality in general surgery
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD November 1
VO 147
IS 11
SP 1000
OP 1007
DO 10.1001/2013.jamasurg.114
UL http://dx.doi.org/10.1001/2013.jamasurg.114
AB Objectives 
                  To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures.Design 
                  Retrospective cohort study.Setting 
                  American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files.Patients 
                  A total of 551 510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting.Main Outcome Measures 
                  Postdischarge complications, reoperation, and mortality.Results 
                  Of 551 510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use.Conclusions 
                  The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.