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

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...

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Bibliographic Details
Published in:	The American surgeon Vol. 81; no. 4; p. 381
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 01-04-2015
Subjects:	Aged Female Follow-Up Studies Hospitals, Community - economics Hospitals, Teaching - economics Humans Incidence Male Medicare - economics 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 Time Factors United States - epidemiology United States
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Summary:	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.
ISSN:	1555-9823
DOI:	10.1177/000313481508100429