Key result
Higher operative severity (P<0.001), increased wound class (P=0.001), and emergency surgery (P=0.001) were significant risk factors for 30-day unplanned readmission in general surgery patients.
Why the study?
Unplanned 30-day readmission is used to measure surgical care quality in high-income countries, but the correlation with mortality, volume, and surgical complexity remains controversial, prompting evaluation in a low- and middle-income country setting.
Cohort (n=9,649)
No
p-value: p=<0.001
In a South African regional hospital, the 30-day general surgery readmission rate was 2.87%, driven primarily by surgical site infections and associated with higher operative severity and emergency procedures.
BACKGROUND: Unplanned readmission within 30 days is currently being used in high-income countries (HICs) for measuring the quality of surgical care. Surgical site infection (SSI), abdominal complaints and pain are the most common causes for such readmission. The correlation between readmission rates and mortality, increased patient volumes and complexity of surgery remains controversial. OBJECTIVES: To explore the risk factors for unplanned readmission in the surgical population in a low- and middle-income country setting. METHODS: This is a retrospective review of prospectively collected data of unplanned 30-day readmissions from January 2014 to December 2017 in the Department of General Surgery, Worcester Hospital, South Africa (SA). Basic patient demographics, reasons for readmission, operative urgency and severity, wound class, length of stay and final outcomes were used to compare the inpatient cohort and identify predictors for unplanned readmission. RESULTS: A total of 9 649 patients were admitted to the general surgery department at Worcester Hospital - 2.87% (n=270) were unplanned readmissions within 30 days. The mean age of this cohort was 42 (standard deviation (SD) 22) years, with 61% male patients. SSI (60.37%; n=163), gastrointestinal complications (24.44%; n=66) and blood transfusion (7.03%; n=19) were the most common causes for readmission. Median initial length of stay (LOS) was 4 days; after readmission it was 5 days. Readmissions were responsible for 1 914 additional patient days. Operative Portsmouth-POSSUM (P-POSSUM) (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score (p<0.001), increase in operative wound classification (p=0.001) and emergency surgical procedures (p=0.001) were significant risk factors for readmission within 30 days. CONCLUSIONS: The Department of General Surgery, Worcester Hospital, had a readmission rate comparable with that in HICs. Readmission rate is an indicator of advanced surgical pathology requiring an operative intervention of greater magnitude, often presenting as an emergency. Our results can be used to improve postoperative surveillance and ultimately improve outcomes in high-risk surgical populations. This study provides a benchmark for other regional hospitals in SA and has implications for quality-improvement programmes.
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Snyders et al. (2020) conducted a cohort in General surgery (n=9,649). High operative severity, increased wound class, and emergency surgery vs. Lower severity, lower wound class, and elective surgery was evaluated on Unplanned readmission within 30 days (p=<0.001). Higher operative severity (P<0.001), increased wound class (P=0.001), and emergency surgery (P=0.001) were significant risk factors for 30-day unplanned readmission in general surgery patients.
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