Readmission after major surgery: effect of the postdischarge environment.
Journal Article (Journal Article)
Background
Although uncoordinated postdischarge care has been associated with poor clinical outcomes, the effect of discharge to a low healthcare resource area (LHRA) on readmission remains undetermined. We sought to assess how the quality of discharge area health resources impact readmission following major surgery.Methods
This cross-sectional study was performed by linking Maryland state data for 2012-2015 to the Agency for Healthcare Research and Quality Area Health-Resource File. Patients undergoing one of 11 common surgical procedures were identified. Multivariable logistic regression was performed to assess the effect of discharge area health resource quality on readmission.Results
A total of 76,747 patients were identified of which 9.4% were discharged to a high healthcare resource area (HHRA), whereas 81.9% of patients were discharged to an LHRA. Perioperative morbidity and length of stay were comparable between HHRA versus LHRA patients (both P > 0.05). Among all patients, 30-d and 90-d readmission was 6.5% and 12.4%, respectively. On multivariable analysis, discharge to LHRA was independently associated with a 19% (odds ratio = 1.19; 95% CI, 1.01-1.41; P = 0.043) and 18% (odds ratio = 1.18; 95% CI, 1.04-1.33; P = 0.010) greater odds of 30-d and 90-day readmission, respectively.Conclusions
Patients discharged to an area characterized by LHRA were more likely to be readmitted at 30 d and 90 d following index discharge.Full Text
Duke Authors
Cited Authors
- Cerullo, M; Gani, F; Chen, SY; Canner, JK; Pawlik, TM
Published Date
- October 2016
Published In
Volume / Issue
- 205 / 2
Start / End Page
- 318 - 326
PubMed ID
- 27664879
Electronic International Standard Serial Number (EISSN)
- 1095-8673
International Standard Serial Number (ISSN)
- 0022-4804
Digital Object Identifier (DOI)
- 10.1016/j.jss.2016.06.080
Language
- eng