Complete Impact of Care Fragmentation on Readmissions Following Urgent Abdominal Operations.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Urgent abdominal operations commonly occurred in low-volume hospitals with high failure-to-rescue rates. Recent studies have demonstrated a survival benefit associated with readmission to the original hospital after operation, presumably due to improved continuity of care. It is unclear if this survival benefit persists in low-volume hospitals. We seek to evaluate differences in mortality between readmission to the original hospital and a higher-volume hospital after urgent abdominal operations. METHODS: A retrospective cohort study using the National Readmissions Database from 2010 to 2014 was performed. Propensity score-weighted multilevel regression analysis was used to examine the association between readmission destination and mortality after accounting for hospital volume. RESULTS: A total of 71,551 adult patients who experienced 30-day readmission following urgent abdominal operations were identified, among whom 10,368 (14.5%) were readmitted to a different hospital. Patients with higher baseline comorbidity scores, lower income, less comprehensive insurance coverage, systemic complications, prolonged length of stay, or non-home disposition were more likely to experience readmission to a different hospital. Following stratification by readmission hospital volume and propensity score weighting to adjust for baseline mortality risk differences, readmission to a different hospital is still associated with higher mortality rates than the original hospital. CONCLUSIONS: The adverse outcomes associated with case fragmentation are present even after adjusting for readmission hospital volume. Patients who received urgent abdominal operations at low-volume hospitals should return to the original hospital for concern of care fragmentation.

Full Text

Duke Authors

Cited Authors

  • Juo, Y-Y; Sanaiha, Y; Khrucharoen, U; Tillou, A; Dutson, E; Benharash, P

Published Date

  • August 2019

Published In

Volume / Issue

  • 23 / 8

Start / End Page

  • 1643 - 1651

PubMed ID

  • 30623376

Pubmed Central ID

  • 30623376

Electronic International Standard Serial Number (EISSN)

  • 1873-4626

Digital Object Identifier (DOI)

  • 10.1007/s11605-018-4033-1

Language

  • eng

Conference Location

  • United States