Analysis of unplanned revisits and readmissions: results of the General Surgery clinic in a private hospital

Abstract

Objectives: In recent years, the rate of readmission (RA) within the first thirty days of discharge has been an important parameter for cost and quality standards. It is therefore extremely important for each center to analyze its own results and determine the factors affecting the RA rates in order to organize the measures to be taken. Another important issue, especially for centers focusing on specific areas of expertise, is unplanned revisit (RV) after discharge. Determination of these rates and reasons is of importance for every hospital and/or clinic to decrease these rates, thus increasing patient satisfaction and reducing costs. The aim of this study was to analyze RA and RV patients operated in the general surgery clinic of our hospital for a period of two years as well as factors affecting these rates.

Methods: The study included patients who were operated in the general surgery clinic of Bursa Private Medicabil Hospital between 1 January 2018 and 31 December 2019 and who revisited and were readmitted within the first thirty days of discharge. The reasons for RA/RV and time to RA/RV, and patients’ treatments were investigated by comparing RA/RV patients with those who were not readmitted (NA) for demographic results at initial admission to determine the differences between these patient groups. Univariate and multivariate analyses were carried out using the SPSS software. The level of significance was set at p < 0.05.

Results: Of the 890 patients who were operated in our clinic throughout the study period and met the study inclusion criteria, 52 (5.8%) were included in the unplanned RA group and 107 (12%) in the unplanned RV group. The mean time to RA was 10.5 ± 7.0 days for the RV group and 8.8 ± 6.7 days for the RA group (p = 0.17). Thirty-two (61.5%) of the RA patients and 41 (38.3%) of the RV patients were readmitted within the first 7 days of discharge (p = 0.003). The multivariate analysis revealed that prolonged length of hospital stay, emergency surgery, abnormal WBC, electrolyte imbalance, and abnormal hemoglobin level were significant risk factors for RV, while the development of complications, prolonged length of hospital stay, and advanced age were significant risk factors for RA.

Conclusions: This study analyzing the RA and RV patients operated in the general surgery clinic of a private hospital demonstrated that the most important reasons for RA were nonspecific and preventable. Patients who developed complications, had prolonged length of hospital stay, and were at an advanced age had a higher rate of RA, while patients who had prolonged length of hospital stay, underwent emergency surgery, and had biochemical problems at initial admission had a higher rate of RV. Focusing on these patients during and after discharge and increasing home care facilities can solve the problems of many patients without admitting them to the hospital. This will be a factor that would improve patient satisfaction while reducing costs.

Keywords

• Unplanned readmission
• unplanned visit
• surgery
• predictive factor

References

1. 1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418-28.
2. 2. Department of Health US Human Services. US National Health-care quality report, 2007. Rockville MD:Agency for healthcare research and quality. 2008: p.137-43.
3. 3. Dimick JB, Ghaferi AA. Hospital readmission as quality measure in surgery. JAMA 2015;313:512-3.
4. 4. Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One 2014;9:e112282.
5. 5. Lucas DJ, Haider A, Haut E, Dodson R, Wolfgang CL, Ahuja N, et al. Assessing readmission after general,vascular and thoracic surgery using ACS-NSQIP. Ann Surg 2013;258:430-9.
6. 6. Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, et al. Risk prediction models for hospital readmission:a systematic review. JAMA 2011;306:1688-98.
7. 7. Orosco RK, Lin HW, Bhattacharyya N. Ambulatory thyroidectomy:a multistate study of revisits and complications. Otolarygol Head Neck Surg 2015;152:1017-23.
8. 8. Orosco RK, Lin HW, Bhattacharyya N. Safety of adult ambulatory direct laryngoscopy: revisits and complications. JAMA Otolarygol Head Neck Surg 2015;141:685-9.

9. 9. Lang BH, Chow FCL. Evaluating the incidence, cause, and risk factors for unplanned 30-day readmission and emergency department/general practitioner visit after short-stay thyroidectomy. World J Surg 2016 40:329-36.
10. 10. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009;250:187-96.
11. 11. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Ad Hoc ESPEN Working Group. Nutrional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36.
12. 12. Beilman GJ, Dunn DL. Surgical Infections. In: F.Charles Brunicardi (ed). Schwartz’s Principles Of Surgery. Tent Edition. New-York:McGraw-Hill, 2015: p.135-58.
13. 13. Wahl TS, Hawn MT. How do we prevent readmissions after major surgery. Adv Surg 2017;51:89-100.
14. 14. Gauduchon L, Sabbagh C, Regimbeau JM. Re-admission after gastro-intestinal surgery. J Visc Surg 2015;152:97-104.
15. 15. Lee MJ, Daniels SL, Wild JRL, Wilson TR; SYSuRG RAGeS Group. Readmissions after general surgery: a prospective multicenter audit. J Surg Res 2017;209:53-9.
16. 16. Dan Z, YiNan D, ZengXi Y, XiChen W, JieBin P, LanNing Y. Thirty-day readmission after radical gastrectomy for gastric cancer: a meta-analysis. J Surg Res 2019;243:180-8.
17. 17. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg 2012;215:322-30.
18. 18. Lucas DJ, Pawlik TM:Readmission after surgery. Adv Surgery 2014;48:185-299.
19. 19. Heilbronn C, Lin H, Bhattacharya N. Adult ambulatory otologic surgery:Unplanned revisits and complications. Laryngoscope 2020;130:1788-91.
20. 20. Bhattacharyya N. Unplanned revisits and readmissions after ambulatory sinonasal surgery. Laryngoscope 2015;124:1983-7.
21. 21. Lee LN, Quatela O, Bhattacharryya N. Postoperative revisits and readmissions after facelift surgery. Laryngoscope 2018;128:2714-17.
22. 22. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011;16:CD007635.
23. 23. Crucitti A, Mazzari A, Tomaiuolo PM, Dionisi P, Diamanti P, Di Flumeri G, et al. Enhanced recovery after surgery(ERAS) is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery:results of a prospective single center study. Minerva Chir 2020;75:157-63.
24. 24. Andersen J, Hjort-Jakobsen D, Christiansen PS, Kehlet H. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg 2007;7:890-3.
25. 25. Merkow RP, Iu MH, Chung JW, Bruce LH, Mark EC, Mark VW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 2015;313:483-95.
26. 26. Dawes AJ, Sacks GD, Russel MM, Anne YL, Melinda MG, Deborah W, et al. Preventable readmissions to surgical services:lessons learned and targets for improvement. J Am Coll Surg 2014;219:382-9.