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Emergency Department Utilization and Readmissions Following Major Surgery: A Retrospective Study of Medicare Data

  • Sharmistha Dev
    Correspondence
    Corresponding Author: William M. Tierney Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street Indianapolis, IN 46202. Tel: (317) 274-9000.
    Affiliations
    Department of Emergency Medicine, Indiana University, Indianapolis, Indiana

    William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana

    Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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  • Andrew A. Gonzalez
    Affiliations
    Department of Surgery, Indiana University, Indianapolis, Indiana

    William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana

    Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
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  • Amir A. Ghaferi
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

    Department of Surgery, University of Michigan, Ann Arbor, Michigan
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  • Brahmajee K. Nallamothu
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

    Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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  • Keith E. Kocher
    Affiliations
    Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

    Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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      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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