ABSTRACT
Background
Reliable strategies for reducing postoperative readmissions remain elusive. As the
emergency department (ED) is a frequent source of post-operative admissions, we investigated
whether hospitals with high readmission rates also have high rates of post-discharge
ED visits and high rates of readmission once an ED visit occurs.
Methods
We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing
1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. We stratified hospitals
into quintiles based on risk-standardized, 30-day post-discharge readmission rates
(RSRR) and then compared rates of post-discharge ED visits, proportion readmitted
from the ED, and readmissions within 7 days of ED discharge across these quintiles.
Results
RSRR varied widely across extremes of hospital quintiles (3.9% to 17.5%). Hospitals
with either very low or very high RSRR had modest differences in rates of ED visits
(12.4% versus 14.6%). In contrast, the proportion readmitted from the ED was nearly 3 times greater
in Hospitals with very high RSRR compared with those with very low RSRR (12% versus 32.2%). These findings were consistent across all procedures. Importantly, hospitals
with a low proportion readmitted from the ED did not exhibit an increased rate of
readmission within 7 days of ED discharge.
Conclusions
Although hospitals experience similar rates of ED visits following major surgery,
some EDs and their affiliated surgeons and health system may deliver care preventing
readmissions without an increased short-term risk of readmission following ED discharge.
Reducing 30-day readmissions requires greater attention to the coordination of care
delivered in the ED.
Keywords
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Article info
Publication history
Published online: May 01, 2021
Accepted:
February 27,
2021
Received in revised form:
February 22,
2021
Received:
October 8,
2019
Footnotes
Author Contribution: Dev, Gonzalez, and Kocher were responsible for study conception and design.Kocher was responsible for acquisition of data. Dev, Gonzalez, and Kocher were responsible for analysis and interpretation of data. Dev and Gonzalez were responsible for drafting the manuscript.Kocher, Ghaferi, and Nallamothu were responsible for critical revision.
Identification
Copyright
Published by Elsevier Inc.
