Reasons for Readmissions after Surgery

CMS’ program to reduce hospital readmissions, a worthy goal, has drawn intense criticism for its design and execution.  Now it is rolling out the program to more conditions, including surgeries.  Be nice to know why readmissions after surgery occur and how many truly are avoidable or not the fault of the hospital, and maybe you would like to know that before you design the reduction program.  A study in the Journal of the American Medical Association tries to fill this gap, not that the policy wonks at CMS are paying any attention.  (JAMA Article)   The researchers used data on readmissions after surgery from 346 hospitals participating in a common quality reporting program.  Six surgeries were examined, bariatric procedures, colectomy, hysterectomy, total hip or knee replacement, ventral hernia repair and leg vascular bypass.  The primary outcomes were unplanned 30-day readmission rates and the reasons for those readmissions.  Overall the rate of readmission across almost a half a million surgeries was 5.7%, ranging from 3.8% for hysterectomy to 14.9% for the leg bypass surgeries.  The most common reason for the readmission across all surgeries was surgical site infection at 19.5% of readmissions.  This clearly should be viewed as preventable, but the reality is that even with a great deal of focus it has been hard for hospitals to reduce these infections..  Other common reasons varied by surgery type but were mostly unrelated to a problem occurring during the original hospitalization.  Only 2.3% of patients were readmitted for a complication that occurred in the initial hospital stay.  So hospitals are potentially being penalized for something that happens after the patient leaves the hospital and which may not be very predicable.  Many of the reasons for readmission also may not be amenable to easy efforts to reduce their occurrence and the difficulty in this task may discourage hospitals from trying, even if they know they may be penalized.  We continue to think that the best way to design these programs is to examine each readmission and make an independent clinical judgment about whether it could have been avoided.