Infection is Leading Cause for Readmission Following Surgery

Hospital readmission has become a major metric for the health care industry and policy makers.  But little research has been done on exactly why patients are readmitted after surgery.

In a new study, researchers have found that post discharge complications — not exacerbation of the original condition — accounted for most readmissions.   The leading cause of patient readmission following surgery was surgical site infections (SSI) followed by obstruction or ileus.

Researchers examined 498,875 patients from 346 hospitals and found that the unplanned readmission rate was 5.7 percent overall. SSI rates were highest in lower extremity vascular bypass (36.4 percent), hysterectomy (28.8 percent), ventral hernia repair (26.5 percent), and colectomy or proctectomy (25.8%).

“Only 2.3 percent of patients were readmitted for the same complication they had experienced during their index hospitalization,” according to the JAMA study, led by Ryan P. Merkow, MD of the Division of Research and Optimal Patient Care, American College of Surgeons, Chicago.

While most U.S. hospitals have implemented infection prevention measures based on the Surgical Care Improvement Project (SCIP), SSI rates have not been significantly reduced.

“The existing high rates of SCIP compliance, coupled with our finding that SSI is the leading cause for readmission, indicates that SSI research should be a major priority for the surgical community if postsurgical readmission rates are to be reduced,” said the authors.

Regarding the issue of policy, “we need to question whether surgical readmissions really should be included as we’re simply double counting complications,” said Karl Y. Bilimoria, MD, study co-author, general surgeon, and Vice President of the Surgical Outcomes and Quality Improvement Center. “These complications are measured in other pay-for-performance initiatives.”

After infection and obstruction, additional reasons for readmission included “dehydration or nutritional deficiency, bleeding or anemia, venous thromboembolism, and prosthesis or graft issues,” said the authors.

-Alan Lyndon