Readmission Rates after Abdominal Surgery: The Role of Surgeon, Primary Caregiver, Home Health, and Sub-acute Rehab
Robert CG Martin, MD*, Russell Brown, MD*, Lisa Puffer, MD*, Stacey Block, MD*, Charles R Scoggins, MD*, Kelly M McMasters, MD
OBJECTIVE(S): Recommendations from MedPAC that the Centers for Medicare and Medicaid Services report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians. Thus the aim of this study was to evaluate predictive factors of hospital readmission rates in patients undergoing major abdominal surgical procedures.
METHODS: Analysis of 266 prospective treated patients from 9/2009-9/2010. All patients were prospectively evaluated for underlying comorbidities, # pre-op meds, surgical procedure, complications, presence of primary caregiver, education level, discharge number of medications, and discharge location.
RESULTS: 266 patients were reviewed with 48(18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58(22%) pancreas, and 33(12%) other. 78(30%) were readmitted for various diagnoses the most common being dehydration(26%). Certain pre-operative and intra-operative factors were not found to be significant for readmission being, co-morbidities, diagnosis, number of pre-operative medications, patient education level, type of operation, blood loss, and complications. Predictive factors for readmission were age (≥67 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake(52% vs 23%), and DC home with a home health agency(70% vs 18%).
CONCLUSIONS: Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are non-existent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary in order to demonstrate improved surgical quality.
|#DC Meds||Oral Intake <50%||DC w/ Home Health||DC to Subacute Rehab|
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