Understanding recurrent readmission after major surgery among patients with employer-provided health insurance

Yuhree Kim, Aslam Ejaz, Li Xu, Faiz Gani, Joseph K. Canner, Eric B. Schneider, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery. Methods: A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured. Results: Median patient age was 55 years, and a slight majority (55.4%) was male. Comorbidities were common as 36.9% had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8%) patients who experienced readmission, 64.0% experienced 1 readmission, whereas 36.0% experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3% vs 44.2%) and have more comorbidities (Charlson comorbidity index ≥2, 49.5% vs 42.5%; both P <.001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5% vs 30.7%, P <.001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P <.001). Among study cohort, 4.5% experienced 3 or more readmissions; these patients accounted for 14.8% of all admissions and 13.7% of hospital charges for the study cohort during the entire follow-up period. Conclusions: Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5% of patients with ≥3 readmissions accounted for 14.8% of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Sep 25 2015

Fingerprint

Health Insurance
Patient Readmission
Comorbidity
Length of Stay
Hospitalization
Cohort Studies
Hospital Charges
Pancreatectomy
Esophagectomy
Carotid Endarterectomy
Abdominal Aortic Aneurysm
Hepatectomy
Gastrectomy
Aortic Valve
Coronary Artery Bypass
Transplants
Lung

Keywords

  • Outcomes
  • Readmission
  • Recurrent readmission
  • Surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Understanding recurrent readmission after major surgery among patients with employer-provided health insurance. / Kim, Yuhree; Ejaz, Aslam; Xu, Li; Gani, Faiz; Canner, Joseph K.; Schneider, Eric B.; Pawlik, Timothy M.

In: American Journal of Surgery, 25.09.2015.

Research output: Contribution to journalArticle

Kim, Yuhree ; Ejaz, Aslam ; Xu, Li ; Gani, Faiz ; Canner, Joseph K. ; Schneider, Eric B. ; Pawlik, Timothy M. / Understanding recurrent readmission after major surgery among patients with employer-provided health insurance. In: American Journal of Surgery. 2015.
@article{9706254ac85247c5b6ae132fa79fd9e8,
title = "Understanding recurrent readmission after major surgery among patients with employer-provided health insurance",
abstract = "Background: Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery. Methods: A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured. Results: Median patient age was 55 years, and a slight majority (55.4{\%}) was male. Comorbidities were common as 36.9{\%} had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8{\%}) patients who experienced readmission, 64.0{\%} experienced 1 readmission, whereas 36.0{\%} experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3{\%} vs 44.2{\%}) and have more comorbidities (Charlson comorbidity index ≥2, 49.5{\%} vs 42.5{\%}; both P <.001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5{\%} vs 30.7{\%}, P <.001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P <.001). Among study cohort, 4.5{\%} experienced 3 or more readmissions; these patients accounted for 14.8{\%} of all admissions and 13.7{\%} of hospital charges for the study cohort during the entire follow-up period. Conclusions: Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5{\%} of patients with ≥3 readmissions accounted for 14.8{\%} of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.",
keywords = "Outcomes, Readmission, Recurrent readmission, Surgery",
author = "Yuhree Kim and Aslam Ejaz and Li Xu and Faiz Gani and Canner, {Joseph K.} and Schneider, {Eric B.} and Pawlik, {Timothy M.}",
year = "2015",
month = "9",
day = "25",
doi = "10.1016/j.amjsurg.2016.01.028",
language = "English (US)",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Understanding recurrent readmission after major surgery among patients with employer-provided health insurance

AU - Kim, Yuhree

AU - Ejaz, Aslam

AU - Xu, Li

AU - Gani, Faiz

AU - Canner, Joseph K.

AU - Schneider, Eric B.

AU - Pawlik, Timothy M.

PY - 2015/9/25

Y1 - 2015/9/25

N2 - Background: Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery. Methods: A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured. Results: Median patient age was 55 years, and a slight majority (55.4%) was male. Comorbidities were common as 36.9% had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8%) patients who experienced readmission, 64.0% experienced 1 readmission, whereas 36.0% experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3% vs 44.2%) and have more comorbidities (Charlson comorbidity index ≥2, 49.5% vs 42.5%; both P <.001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5% vs 30.7%, P <.001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P <.001). Among study cohort, 4.5% experienced 3 or more readmissions; these patients accounted for 14.8% of all admissions and 13.7% of hospital charges for the study cohort during the entire follow-up period. Conclusions: Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5% of patients with ≥3 readmissions accounted for 14.8% of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.

AB - Background: Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery. Methods: A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured. Results: Median patient age was 55 years, and a slight majority (55.4%) was male. Comorbidities were common as 36.9% had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8%) patients who experienced readmission, 64.0% experienced 1 readmission, whereas 36.0% experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3% vs 44.2%) and have more comorbidities (Charlson comorbidity index ≥2, 49.5% vs 42.5%; both P <.001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5% vs 30.7%, P <.001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P <.001). Among study cohort, 4.5% experienced 3 or more readmissions; these patients accounted for 14.8% of all admissions and 13.7% of hospital charges for the study cohort during the entire follow-up period. Conclusions: Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5% of patients with ≥3 readmissions accounted for 14.8% of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.

KW - Outcomes

KW - Readmission

KW - Recurrent readmission

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84965010279&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84965010279&partnerID=8YFLogxK

U2 - 10.1016/j.amjsurg.2016.01.028

DO - 10.1016/j.amjsurg.2016.01.028

M3 - Article

C2 - 27156797

AN - SCOPUS:84965010279

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

ER -