American Surgical Association Home American Surgical Association Annual Meeting
Search Meeting Site Only
Annual Meeting Home
Program
Past & Future Meetings

 

 

Back to Annual Meeting Abstracts


Assessing Risk Of Readmission After General, Vascular, And Thoracic Surgery Using ACS-NSQIP
Timothy M Pawlik1, Donald Lucas*2, Omar Hyder*1, Rebecca Dodson*1, Nita Ahuja*1, Christopher Wolfgang*1, Eric Schneider*1, Michael Choti1
1Johns Hopkins, Baltimore, MD;2Walter Reed National Military Medical Center, Bethesda, MD

OBJECTIVE(S): In 2012, Medicare began cutting reimbursement for hospitals with high 30-day readmission rates. We sought to define the incidence and risk factors associated with readmission after surgery.
METHODS: 240,125 patients discharged after general, upper gastrointestinal (GI), colorectal, hepato-pancreato-biliary (HPB), vascular, and thoracic surgery were identified using 2011 ACS-NSQIP. Readmission rates and patient characteristics were analyzed using regression and receiver-operator curves.
RESULTS: Median patient age was 56 years, 43% were male, and median ASA class was 2 (general surgery: 2; upper GI: 3; colorectal: 2; HPB: 3; vascular: 3; thoracic: 3). Median length-of-stay (LOS) was 1 day (general surgery: 1 day; upper GI: 2 days; colorectal: 4 days; HPB: 6 days; vascular: 2 days; thoracic: 4 days). Overall 30-day readmission was 8.1%; readmission varied between subspecialties (general surgery: 7.3%; upper GI: 6.9%; colorectal: 10.0%; HPB: 15.9%; vascular: 12.4%; thoracic: 11.1%; p<0.001). Factors associated with readmission included ASA class, functional status, dialysis, inpatient complications, and LOS (all p<0.001). On multivariate analysis, ASA class (RR 4.31, 95%-CI 3.76-4.94) and LOS (RR 2.49, 95%-CI 2.49-2.59) remained most strongly associated with readmission. A simple integer-based model using ASA class and LOS predicted risk of readmission across subspecialties (AUC 0.702) (Figure).
CONCLUSIONS: Readmission occurs at an incidence of 7-16% across surgical subspecialties. A scoring system based on ASA class and LOS can accurately assess readmission risk to target interventions.


Back to Annual Meeting Abstracts

 



© 2019 American Surgical Association. All Rights Reserved. Privacy Policy.