Nearly one in seven patients bounces back to the hospital after major surgery, according to a new report in the New England Journal of Medicine.
The researchers used national Medicare data to calculate 30-day readmission rates after several major procedures, among them pulmonary lobectomy, colectomy, hip replacement, coronary-artery bypass grafting and open repair of abdominal aortic aneurysm. The researchers found:
hospitals with the lowest surgical mortality rates had a much lower readmission rate than hospitals with the highest mortality rates (13.3 and 14.2 percent, respectively);
hospitals in the highest quartile for surgical volume had a much lower composite readmission rate than those in the lowest quartile (12.7 and 16.8 percent, respectively);
adherence to surgical process did not correlate strongly with reduced readmission rates, with only a 0.5 percent difference between readmission rates in the lowest and highest quartiles.
The study also found hospitals with low rates of post-surgery readmission were likely to be nonprofit, nonteaching hospitals located in the West, have a lower proportion of Medicaid patients, and have more full-time nurses per 1,000 patient-days, according to MedPage Today.
Hospitals are putting more focus on reducing readmissions as new payment models penalize hospitals for high rates. The second round of Medicare readmission penalties will fine two-thirds of U.S. hospitals, after slapping nearly 300 with the maximum penalty in the first round.
"There aren't too many new advances that would reduce costs and improve care," Brian Jack, M.D., of Boston University, told MedPage Today, "but cutting readmission rates is one of them."
Meanwhile, a 2012 study in the Journal of the American College of Surgeons found that one in 10 general surgery patients readmit to the hospital. The biggest drivers of readmission, according to the study, included gastrointenstinal problems/complications, surgical infections and malnutrition/failure to thrive, FierceHealthcare previously reported.