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Early Versus Late Hospital Readmission After Major Procedures Among Patients With Employer-Provided Health Insurance
Yuhree Kim*, Gaya Spolverato*, Aslam Ejaz*, Joe Canner*, Eric Schneider*, Timothy M Pawlik
Johns Hopkins, Baltimore, MD

INTRODUCTION: Most studies report only data on readmission within 30-days of discharge from the same hospital. These data may underestimate readmission, as patients may be readmitted beyond 30-days and/or at other hospitals. We sought to define the incidence of early versus late hospital readmission among surgical patients.
METHODS: Patients discharged after ten major surgical procedures (CABG, AAA, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, lobectomy, hepatectomy, colectomy, and cystectomy) between 2010-2012 were identified from a large employer-sponsored health plan.
RESULTS: 228,144 patients were identified; mean patient age was 52.6 years, 58.2% were male, and 40.7% had Charlson Comorbidity Index of ≥2. Median(IQR) length-of-stay was 5(3, 8) days. Among the 73,498(32.2%) patients who experienced readmission, 27,523(37.5%) had a readmission within 30-days while 16,208(22.1%) were readmitted within 31-90 days. In-hospital mortality was higher among patients re-admitted early(2.7% vs. 1.9%, P<0.001). Among patients readmitted, 45.7% were re-admitted to a different hospital than where the index procedures had been performed. Both early (index hospital:63.0% vs. non-index hospital:37.0%) and late(index hospital:60.0% vs. non-index hospital:40.0%) readmissions were more likely to occur at the index hospital(P=0.007). In-hospital mortality at index vs. non-index hospitals either among patients with early readmission(index hospital: 3.0% vs. non-index hospital: 2.7%) or late readmission(index hospital:1.3% vs. non-index hospital:2.2%) was comparable(both P>0.05).
CONCLUSIONS: Most readmissions occurred beyond 30-days, with approximately half of them occurring at non-index hospitals after major surgical procedures. Assessment of only 30-day same hospital readmissions underestimates the true incidence of re-hospitalization.


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