American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

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Pubmed link to abstract:

Underlying reasons associated with hospital readmission following surgery in the United States
Merkow R, Ju MH, Chung JW, et al. JAMA. 2015 Feb 3;313(5):483-95. doi: 10.1001/jama.2014.18614.

Merkow and colleagues collected readmission information from American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®)-participating hospitals and found that the most frequent causes of postoperative readmission were surgical site infection (19.5%) and bowel obstruction or ileus (10.3%). Readmissions are often due to new postoperative complications that surfaced after discharge. 

The authors explain that because readmissions are often due to postoperative complications, pay-for-performance programs that penalize hospitals for readmissions are effectively penalizing hospitals twice for the same complication. The authors further explain that surgical site infection is the leading cause of postoperative readmission despite high compliance with national infection prevention guidelines.  Implementations of additional policies to prevent surgical site infection and readmission without evidence-based solutions to prevent these complications may be counterproductive.

Key Points

The authors identified three opportunities to reduce readmissions

  • Better care coordination with the outpatient care team
  • Improved  communication amongst caregivers when a patient presents at a hospital other than that where the index procedure was performed
  • More effective patient education to set patient expectations and improve patients understanding or potential complications