Early versus late readmission after surgery among patients with employer-provided health insurance

Yuhree Kim, Faiz Gani, Donald J. Lucas, Aslam Ejaz, Gaya Spolverato, Joseph K. Canner, Eric B. Schneider, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Objectives: To define the incidence of 90-day readmission and characterize the factors associated with 90-day readmission after 10 major surgical procedures. Background: Most data on readmission focus solely on same hospital readmission (index hospitals) within 30 days of discharge. These studies may underestimate readmission, as patients may be readmitted beyond 30 days of discharge or to other non-index hospitals. Methods: Patients discharged after 10 major surgical procedures (coronary artery bypass grafting, abdominal aortic aneurysm repair, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, pulmonary resection, hepatectomy, colectomy, and cystectomy) between 2010 and 2012 were identified from the Truven Health MarketScan Commercial Claims and Encounters database. Multivariable logistic regression analysis was performed to identify determinants of early (≤30 days) and late (31-90 days) readmission. Results: A total of 158,753 patients were identified; 60.3% were male, and 42.3% had a Charlson Comorbidity Index of 2 or more. A total of 26,817 (16.9%) patients were readmitted within 90 days [early: 16,419 (10.4%) vs late: 10,398 (6.5%)]. Among readmitted patients, 38.3% were readmitted to a different hospital than the index hospital. Both early and late readmissions were more common at the index versus non-index hospital (early: 83.9% vs 16.1%; late: 75.0% vs 25.0%; both P<0.001). In-hospital mortality after early readmission and late readmission was found to be lower at index hospitals than that at non-index hospitals (early; 0.7% vs 2.5%, P = 0.04; late; 0.2% vs 2.0%, P = 0.02). Conclusions: More than one-third of readmission occurred after 30 days of index discharge. Approximately 20% of patients were readmitted to non-index hospitals. Assessment of 30-day same hospital readmissions underestimated the true incidence of readmission.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalAnnals of Surgery
Volume262
Issue number3
DOIs
StatePublished - Sep 1 2015

Fingerprint

Health Insurance
Patient Readmission
Pancreatectomy
Esophagectomy
Colectomy
Carotid Endarterectomy
Cystectomy
Incidence
Abdominal Aortic Aneurysm
Hepatectomy
Hospital Mortality
Aortic Valve
Coronary Artery Bypass
Comorbidity
Logistic Models
Regression Analysis
Databases
Lung
Health

Keywords

  • Care fragmentation
  • Late readmission
  • Readmission
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Kim, Y., Gani, F., Lucas, D. J., Ejaz, A., Spolverato, G., Canner, J. K., ... Pawlik, T. M. (2015). Early versus late readmission after surgery among patients with employer-provided health insurance. Annals of Surgery, 262(3), 502-509. https://doi.org/10.1097/SLA.0000000000001429

Early versus late readmission after surgery among patients with employer-provided health insurance. / Kim, Yuhree; Gani, Faiz; Lucas, Donald J.; Ejaz, Aslam; Spolverato, Gaya; Canner, Joseph K.; Schneider, Eric B.; Pawlik, Timothy M.

In: Annals of Surgery, Vol. 262, No. 3, 01.09.2015, p. 502-509.

Research output: Contribution to journalArticle

Kim, Y, Gani, F, Lucas, DJ, Ejaz, A, Spolverato, G, Canner, JK, Schneider, EB & Pawlik, TM 2015, 'Early versus late readmission after surgery among patients with employer-provided health insurance', Annals of Surgery, vol. 262, no. 3, pp. 502-509. https://doi.org/10.1097/SLA.0000000000001429
Kim, Yuhree ; Gani, Faiz ; Lucas, Donald J. ; Ejaz, Aslam ; Spolverato, Gaya ; Canner, Joseph K. ; Schneider, Eric B. ; Pawlik, Timothy M. / Early versus late readmission after surgery among patients with employer-provided health insurance. In: Annals of Surgery. 2015 ; Vol. 262, No. 3. pp. 502-509.
@article{e3e1d94bb1d643298b9ac995dd67948f,
title = "Early versus late readmission after surgery among patients with employer-provided health insurance",
abstract = "Objectives: To define the incidence of 90-day readmission and characterize the factors associated with 90-day readmission after 10 major surgical procedures. Background: Most data on readmission focus solely on same hospital readmission (index hospitals) within 30 days of discharge. These studies may underestimate readmission, as patients may be readmitted beyond 30 days of discharge or to other non-index hospitals. Methods: Patients discharged after 10 major surgical procedures (coronary artery bypass grafting, abdominal aortic aneurysm repair, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, pulmonary resection, hepatectomy, colectomy, and cystectomy) between 2010 and 2012 were identified from the Truven Health MarketScan Commercial Claims and Encounters database. Multivariable logistic regression analysis was performed to identify determinants of early (≤30 days) and late (31-90 days) readmission. Results: A total of 158,753 patients were identified; 60.3{\%} were male, and 42.3{\%} had a Charlson Comorbidity Index of 2 or more. A total of 26,817 (16.9{\%}) patients were readmitted within 90 days [early: 16,419 (10.4{\%}) vs late: 10,398 (6.5{\%})]. Among readmitted patients, 38.3{\%} were readmitted to a different hospital than the index hospital. Both early and late readmissions were more common at the index versus non-index hospital (early: 83.9{\%} vs 16.1{\%}; late: 75.0{\%} vs 25.0{\%}; both P<0.001). In-hospital mortality after early readmission and late readmission was found to be lower at index hospitals than that at non-index hospitals (early; 0.7{\%} vs 2.5{\%}, P = 0.04; late; 0.2{\%} vs 2.0{\%}, P = 0.02). Conclusions: More than one-third of readmission occurred after 30 days of index discharge. Approximately 20{\%} of patients were readmitted to non-index hospitals. Assessment of 30-day same hospital readmissions underestimated the true incidence of readmission.",
keywords = "Care fragmentation, Late readmission, Readmission, Surgery",
author = "Yuhree Kim and Faiz Gani and Lucas, {Donald J.} and Aslam Ejaz and Gaya Spolverato and Canner, {Joseph K.} and Schneider, {Eric B.} and Pawlik, {Timothy M.}",
year = "2015",
month = "9",
day = "1",
doi = "10.1097/SLA.0000000000001429",
language = "English (US)",
volume = "262",
pages = "502--509",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Early versus late readmission after surgery among patients with employer-provided health insurance

AU - Kim, Yuhree

AU - Gani, Faiz

AU - Lucas, Donald J.

AU - Ejaz, Aslam

AU - Spolverato, Gaya

AU - Canner, Joseph K.

AU - Schneider, Eric B.

AU - Pawlik, Timothy M.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - Objectives: To define the incidence of 90-day readmission and characterize the factors associated with 90-day readmission after 10 major surgical procedures. Background: Most data on readmission focus solely on same hospital readmission (index hospitals) within 30 days of discharge. These studies may underestimate readmission, as patients may be readmitted beyond 30 days of discharge or to other non-index hospitals. Methods: Patients discharged after 10 major surgical procedures (coronary artery bypass grafting, abdominal aortic aneurysm repair, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, pulmonary resection, hepatectomy, colectomy, and cystectomy) between 2010 and 2012 were identified from the Truven Health MarketScan Commercial Claims and Encounters database. Multivariable logistic regression analysis was performed to identify determinants of early (≤30 days) and late (31-90 days) readmission. Results: A total of 158,753 patients were identified; 60.3% were male, and 42.3% had a Charlson Comorbidity Index of 2 or more. A total of 26,817 (16.9%) patients were readmitted within 90 days [early: 16,419 (10.4%) vs late: 10,398 (6.5%)]. Among readmitted patients, 38.3% were readmitted to a different hospital than the index hospital. Both early and late readmissions were more common at the index versus non-index hospital (early: 83.9% vs 16.1%; late: 75.0% vs 25.0%; both P<0.001). In-hospital mortality after early readmission and late readmission was found to be lower at index hospitals than that at non-index hospitals (early; 0.7% vs 2.5%, P = 0.04; late; 0.2% vs 2.0%, P = 0.02). Conclusions: More than one-third of readmission occurred after 30 days of index discharge. Approximately 20% of patients were readmitted to non-index hospitals. Assessment of 30-day same hospital readmissions underestimated the true incidence of readmission.

AB - Objectives: To define the incidence of 90-day readmission and characterize the factors associated with 90-day readmission after 10 major surgical procedures. Background: Most data on readmission focus solely on same hospital readmission (index hospitals) within 30 days of discharge. These studies may underestimate readmission, as patients may be readmitted beyond 30 days of discharge or to other non-index hospitals. Methods: Patients discharged after 10 major surgical procedures (coronary artery bypass grafting, abdominal aortic aneurysm repair, carotid endarterectomy, aortic valve replacement, esophagectomy, pancreatectomy, pulmonary resection, hepatectomy, colectomy, and cystectomy) between 2010 and 2012 were identified from the Truven Health MarketScan Commercial Claims and Encounters database. Multivariable logistic regression analysis was performed to identify determinants of early (≤30 days) and late (31-90 days) readmission. Results: A total of 158,753 patients were identified; 60.3% were male, and 42.3% had a Charlson Comorbidity Index of 2 or more. A total of 26,817 (16.9%) patients were readmitted within 90 days [early: 16,419 (10.4%) vs late: 10,398 (6.5%)]. Among readmitted patients, 38.3% were readmitted to a different hospital than the index hospital. Both early and late readmissions were more common at the index versus non-index hospital (early: 83.9% vs 16.1%; late: 75.0% vs 25.0%; both P<0.001). In-hospital mortality after early readmission and late readmission was found to be lower at index hospitals than that at non-index hospitals (early; 0.7% vs 2.5%, P = 0.04; late; 0.2% vs 2.0%, P = 0.02). Conclusions: More than one-third of readmission occurred after 30 days of index discharge. Approximately 20% of patients were readmitted to non-index hospitals. Assessment of 30-day same hospital readmissions underestimated the true incidence of readmission.

KW - Care fragmentation

KW - Late readmission

KW - Readmission

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84942518001&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942518001&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000001429

DO - 10.1097/SLA.0000000000001429

M3 - Article

VL - 262

SP - 502

EP - 509

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -