Almost 1 in 5 hospital readmissions after surgery are potentially preventable

Potentially preventable readmissions account for 17.8% of all hospital readmissions after surgery, with a greater likelihood of readmission among patients who have public health insurance, according to results of a retrospective cohort study.

“Patients with common comorbidities, including congestive heart failure, chronic obstructive pulmonary disease, hypertension, end-stage kidney disease and diabetes, have been shown to have higher rates of postsurgical complications, but the underlying mechanisms associated with readmissions after surgery are complex and poorly understood,” Craig S. Brown, MD, MSc, a resident physician in the department of surgery at the University of Michigan, and colleagues wrote. “As such, the degree to which they can potentially be prevented remains unknown.”

Brown and colleagues conducted a retrospective cohort study using data from 1,937,354 patients (54.1% women; mean age, 66.1 years) in the 2017 National Readmissions Database. The researchers considered a readmission to be potentially preventable if the primary diagnosis code was superficial surgical site infection, acute kidney injury, aspiration pneumonitis or any of the conditions listed by the Agency for Healthcare Research and Quality’s ambulatory care sensitive conditions guidelines. The study’s main outcome measure was 90-day readmission rates, and readmission rates that met the criteria for being potentially preventable.

Among all 90-day readmissions, 17.8% met the criteria for being potentially preventable, which the researchers estimated cost around $296 million. The most common conditions were congestive heart failure exacerbation (34.6%), pneumonia (12.0%) and acute kidney injury (22.5%), according to the researchers.

The data also showed that patients who had Medicare or Medicaid insurance had greater odds for potentially preventable readmission vs. patients with private insurance (adjusted OR [aOR] = 2.09; 95% CI, 1.94-2.25). Patients aged 65 years and older who had private insurance had lower odds for potentially preventable readmission (aOR = 0.82; 95% CI, 0.74-0.9).

“Our results demonstrate that, of the 8.5% of patients who were readmitted within 90 days after several common surgical procedures, 17.8% of such readmissions were for reasons that may be preventable with improved access to outpatient services,” the researchers wrote. “Furthermore, having several comorbidities, a lower income and a public primary payer were associated with readmission for potentially preventable reasons, suggesting that targeted interventions to this high-risk group of patients may be a potential pathway to decreasing postoperative readmissions and may result in substantial cost savings to the U.S. health care system.”