One in 10 surgical patients readmitted with post-op complications

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About one in 10 general surgery patients return to the hospital, mostly due to postoperative complications, according to a study published in the September Journal of the American College of Surgeons.

Researchers looked at hospitals enrolled in the American College of Surgeons National Surgical Quality Improvement Program. Out of nearly 1,500 general surgery patients, 11.3 percent were readmitted to the hospital within 30 days. Although there are multiple risk factors for readmissions, particularly for surgical patients, researchers noted that postoperative complications were the biggest driver for frequent fliers: gastrointestinal problems/complications (27.6 percent), surgical infections (22.1 percent) and failure to thrive/malnutrition (10.4 percent).

"Hospital readmissions are the tip of the iceberg, but when you dig deeper, it is the postoperative complications that drive readmissions among general surgical patients," said senior study author John F. Sweeney, M.D., chief of division of general and gastrointestinal surgery at Emory University School of Medicine in Atlanta.

Patients who underwent pancreatectomy, colectomy and liver resection procedures saw the most readmissions.

Not surprisingly, the more postoperative complications a patient has, the higher the risk of readmission. Patients who had one or more complications after an operation were four times more likely to be readmitted to the hospital, compared with those who had no complications, the American College of Surgeons noted in a research announcement yesterday. The risk increases if the complication happens at home rather than at the hospital.

Complications also led to longer hospital stays. While patients with no complications had a median length of stay of five days, patients with one complication stayed for nine days; patients with three or more complications stayed in the hospital for 24 days.

The study comes just a couple months before hospitals will start to see reduced reimbursements because of high readmission rates. Starting in October, hospitals with high readmission rates could be dinged anywhere from 0.42 percent to 1 percent of revenue, which could run well into the high six or low seven figures a year for single, large facilities, FierceHealthFinance reported.

In 2009, about 12.7 percent of all U.S. patients discharged after surgery returned within 30 days, LifeHealthPRO reported. The states with higher-than-national-average readmission rates included New York (15.9 percent), New Jersey (14.9 percent) and Connecticut (13.3 percent).

"The biggest bang for the buck is going to be a combination of decrease of complications and decrease of length of stay, resulting in decrease of readmissions," Sweeney said. "Decreasing complications will benefit the patient, the hospital and the payer and will improve quality of care," he said. "It will decrease length of stay and decrease hospital readmissions," he concluded.

For more information:
- check out the study abstract
- read the research announcement
- see the LifeHealthPRO article

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