Readmission to a different hospital after major surgery was associated with 48% higher odds of 30-day mortality compared to readmission to the index hospital (OR 1.48; 95% CI 1.24-1.78; P<.001).
Observational (n=93,062)
Yes
Does postdischarge surgical care fragmentation (readmission to a different hospital) increase 30-day surgical mortality in elderly patients undergoing major surgery?
Postdischarge care fragmentation, defined as readmission to a non-index hospital, is associated with a substantially higher risk of 30-day mortality among older US patients undergoing major surgery.
Effect estimate: OR 1.48 (95% CI 1.24-1.78)
p-value: p=<.001
Importance Despite policies aimed at incentivizing clinical integration, few data exist on whether fragmentation of care is associated with worse outcomes for elderly patients undergoing major surgery. Objective To determine whether postdischarge surgical care fragmentation is associated with worse outcomes and whether distances between hospitals explain differences in patient outcomes. Design, Setting, and Participants We used the 100% Medicare inpatient file for claims from January 1, 2009, through November 30, 2011. Data on hospital structural features, including zip code of location, were obtained from the 2011 American Hospital Association Annual Survey. We identified patients who underwent coronary artery bypass grafting, pulmonary lobectomy, endovascular abdominal aortic aneurysm repair, open abdominal aortic aneurysm repair, colectomy, and hip replacement. Main Outcomes and Measures Thirty-day surgical mortality. Results A total of 93 062 patients who underwent the surgical procedures of interest were subsequently readmitted within 30 days of discharge; 23 278 of these patients (25.0%) were readmitted to a hospital other than the one where their procedure was performed. Patients who were readmitted to a different hospital generally lived farther from the index hospital than those who were readmitted to the index hospital (20.7 vs 7.4 miles,P P Conclusions and Relevance Of older US patients undergoing major surgery, 1 in 4 is readmitted to a hospital other than the one where the initial operation was performed. Even taking distance traveled into account, postsurgical care fragmentation is associated with a substantially higher risk of death. Focusing on clinical integration may improve outcomes for older US patients undergoing complex surgery.
Tsai et al. (Thu,) conducted a observational in Major surgery (n=93,062). Readmission to a different hospital (care fragmentation) vs. Readmission to the index hospital was evaluated on Thirty-day surgical mortality (OR 1.48, 95% CI 1.24-1.78, p=<.001). Readmission to a different hospital after major surgery was associated with 48% higher odds of 30-day mortality compared to readmission to the index hospital (OR 1.48; 95% CI 1.24-1.78; P<.001).