Readmission After Surgery Likely Not Due to Problems with Medical Care

Article

Highest risk factors for readmissions include having Medicare or Medicaid insurance.

Factors such as mental health, substance abuse, and homelessness were found to increase hospital readmission after general surgery, rather than poor medical care or disease progression.

Included in the study, published in JAMA Surgery, were data from 173 patients who had unplanned readmissions within 30 days of general surgery.

Approximately 17% of readmitted patients initially had operations to drain soft tissue infections from injection drug use. These patients were readmitted for new soft tissue infections.

Another 14.5% of readmitted patients did not have social support, such as a home for telephone calls and follow-up appointments not scheduled or attended, according to the study. These factors created issues with discharge and follow-up processes.

These groups combined for approximately one-third of all readmissions. Researchers found that 13% of patients had other undetected infections when admitted, and 9% of patients had illnesses related to their injury or condition.

An additional 9% of patients were readmitted with a complication that was preventable. Only 1% were readmitted due to worsening medical conditions.

According to the study, the highest risk factors for readmission were: female sex, diabetes, sepsis on admission, intensive care unit stay during admission, discharge to respite care, and Medicare or Medicaid insurance.

"Many cases of readmissions may truly be unavoidable in our current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the authors concluded. "Because interventions to reduce the risk of readmission for any group of patients can be costly and labor intensive, identification of the highest risk cohort for readmission can allow more targeted intervention for this population of socially vulnerable patients."

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