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Readmission of acute care surgical patients: Predicting risk and determining causes
*Michael L Stern, David E Clark, *Elizabeth Cummings, *Jay B Cushing, Brad M Cushing
Maine Medical Center, Portland, ME

Objective: To determine factors associated with readmission of acute surgical patients.
Design: Retrospective cohort.
Setting: All NSQIP participating hospitals.
Participants: Data on general surgical patients who underwent emergency operation (“acute care”) were obtained from the 2011 NSQIP Participant Use File (PUF). Complications occurring before the day of discharge were distinguished from those occurring later. Logistic regression models were constructed to predict unplanned readmission, using information available at the time of discharge. Post-discharge complications were tabulated for readmitted patients. Reasons for readmission were verified by chart review of NSQIP cases contributed by our hospital.
Main Outcome Measures: Post-discharge complications and unplanned readmissions.
Results: NSQIP/PUF contained 33,572 “acute care” discharges, of which 2303 (6.9%) resulted in readmission. Readmission was more likely with ASA>2, disseminated cancer, COPD, hyperbilirubinemia, steroid use, chronic dialysis, emergency operations other than appendectomy, or LOS>2 days. Overall C-Statistic was 0.70. Among readmitted PUF patients 956 (41.5%) had a newly-identified complication after discharge, and 740 (77.4%) of these complications were infections, predominantly of the surgical site, urinary tract, or lungs. Among 178 “acute care” NSQIP cases contributed by our hospital, 16 (9.0%) had an unplanned readmission, of which 8 (50%) had a newly-identified complication, including one surgical site infection; 2 patients (13%) were readmitted for reasons unrelated to the operation, and the remainder had pain or other concerns related to the operation but without a specifically identifiable complication.
Conclusions: Hospital readmissions after acute care surgery are difficult to predict at the time of discharge. However, about half are associated with a specific complication first detected after discharge, especially infection at the surgical site.


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Abstract Submission Deadline:
May 5, 2014

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August 13, 2014

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August 11, 2014
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