Reasons for 30-day postoperative readmissions for Medicare patients at a community-based teaching hospital

• Published in: The American surgeon Vol. 81; no. 4; pp. 381 - 386
• Main Authors: Kirsch, Jennifer L, Kothari, Shanu N, Ausloos, Janelle M, Gundrum, Jacob D, Kallies, Kara J
• Format: Journal Article
• Language: English
• Published: United States SAGE PUBLICATIONS, INC 01.04.2015
• Subjects: Aged; Bone surgery; Cost control; Drug overdose; Female; Follow-Up Studies; Gastrointestinal surgery; Health care policy; Hospitalization; Hospitals; Hospitals, Community - economics; Hospitals, Teaching - economics; Humans; Incidence; Male; Medical records; Medicare; Medicare - economics; Mortality; Patient admissions; Patient Discharge - economics; Patient Discharge - trends; Patient Readmission - economics; Patient Readmission - trends; Postoperative Complications - economics; Postoperative Complications - epidemiology; Reimbursement Mechanisms - economics; Retrospective Studies; Risk Assessment - methods; Risk Factors; Surgical outcomes; Time Factors; United States - epidemiology; United States
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481508100429

Healthcare reform initiatives have proposed reducing reimbursement for certain 30-day readmissions among Medicare patients. Our objective was to evaluate the incidence and reasons for 30-day postoperative readmissions at our institution. The medical records of Medicare patients who underwent surgery from January 1, 2010, through May 16, 2011, were reviewed. Statistical analysis included χ(2), Wilcoxon rank sum, and t tests. Two thousand eight hundred sixty-five patients were included; 199 (7%) had a 30-day readmission. The readmission group included a higher proportion of men (53.8 vs 43.6%, P = 0.005), and patients with an American Society of Anesthesiologists (ASA) Class 3 or greater (84 vs 66%, P < 0.001) versus the nonreadmission group. Mean index length of stay and operative time were longer in the readmitted versus nonreadmitted group (4.8 vs 2.8 days, P < 0.001; 122.8 vs 98.2 minutes, P < 0.001). Readmission reasons were surgically related (53%), surgically unrelated (35%), planned (7%), and patient-related (5%). Higher 30-day postoperative readmission rates were associated with male sex, higher ASA class, and longer index length of stay and operative time. Reasons for readmission included surgical- and patient-related factors. Decreased reimbursement should be discouraged for readmissions directly related to patient noncompliance.