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To Your Health: NLM update Transcript

High Post-Surgical Hospital Readmission?: 04/20/2015

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I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine.

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The rate of unplanned, post-surgical readmissions that were primarily attributable to the initial surgery was about 5.7 percent in 346 U.S. hospitals in 2012, finds a comprehensive study recently published in the Journal of the American Medical Association.

While an accompanying editorial acknowledges these and the study’s other findings are sobering, the editorial’s author counters they provide the type of detail needed to reduce future patient re-hospitalization.

The study, based on data from 346 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program in 2012, found readmission rates varied from 3.8 percent for a hysterectomy to almost 15 percent for a leg artery bypass.

The study’s nine authors note surgical side infections accounted for almost 20 percent of all unplanned hospital readmissions. Among the patients who had a leg artery bypass, about 36 percent were re-hospitalized because of surgical site infections. 

In contrast, 11 percent of the adults who received colectomy/proctectomy (colon) surgery were readmitted to the hospital. Of these patients, about 26 percent were re-hospitalized because of surgical site infections.

The study’s findings were based on almost 499,000 reported surgical procedures within 346 participating hospitals in 2012. The authors explained the study assessed the aggregate of all surgeries and then, focused on six surgical procedures that frequently are used in public reporting of hospital data and pay-for-performance data required by the federal government and private insurers.

The editorial’s author writes (and we quote): ‘The findings… are noteworthy because they are derived from analysis of… data, widely regarded as among the most reliable measures of quality’ (end of quote). The editorial’s author continues that prior studies (and we quote): ‘rely on administrative data, which are known to have major deficiencies’ (end of quote).

The editorial’s author writes the study’s primary findings and we quote: ‘will not surprise most surgeons’ (end of quote).

Yet, the editorial’s author, a faculty member at Harvard University School of Public Health, notes the findings suggest postoperative readmissions are more likely to be caused by breakdowns in the health care delivery system rather than the individual carelessness of surgeons or other attending health care providers.

The editorial’s author suggests a combination of pragmatic initiatives could result in significant quality improvements. These include: intensive training in safety science, care improvement teams that include physicians, nurses and hospital executives, and teamwork tools.

The editorial’s author notes there should be increased attention to (and intra-professional communication about) surgeons who maintain a history of low post-operative complications. The editorial’s author explains the latter process recently improved cardiac bypass surgery re-hospitalization rates in some New England medical centers.

Overall, the editorial’s author finds the study’s sobering findings may be empowering for those who wish to improve post-surgical re-hospitalization rates.

Meanwhile, there are a number of resources about postoperative care on MedlinePlus.gov’s after surgery health topic page. For example, a website from the U.S. Centers for Disease Controls and Prevention (which answers questions about surgical site infections) is available within the ‘related issues’ section of MedlinePlus.gov’s after surgery health topic page.

Helpful insights to better understand what to expect after a heart transplant, a lung transplant, heart surgery and several other procedures (all from the National Heart, Lung, and Blood Institute) are available in the ‘specific conditions’ section of MedlinePlus.gov’s after surgery health topic page.

MedlinePlus.gov’s after surgery health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about postoperative care as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s after surgery health topic page type ‘after surgery’ in the search box on MedlinePlus.gov’s home page, then, click on ‘after surgery (National Library of Medicine).’ MedlinePlus.gov also contains health topic pages on surgery as well as many specific surgical procedures.

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