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Complications Following Surgery Predict Costly Readmissions

Online tool helps clinicians flag high-risk patients

The presence — or absence — of complications following surgery is a strong indicator of which patients are likely to be readmitted to the hospital in the 30 days after their procedure, according to a new study published in JAMA Surgery. Predicting which patients are most likely to experience complications using a simple online tool may allow healthcare professionals to flag patients at high risk of readmission in real time and alter care to reduce expensive trips back to the hospital.

The study examined more than 142,000 patients who had non-cardiac surgery using the American College of Surgeons’ National Surgical Quality Improvement Program database. After controlling for the severity of disease and surgical complexity, analyses showed that the rate of unplanned 30-day readmissions was approximately 78% for patients with any complication diagnosed following discharge from the hospital. In contrast, the rate of unplanned 30-day readmissions was less than 5% for patients without any complications.

Currently, hospitals do not have a way to identify surgical patients who are at high risk for unplanned re-hospitalizations. However, an online tool — the American College of Surgeon’s Surgical Risk Calculator — allows health care professionals to enter patient information, such as age, body mass index, and smoking status, and to obtain an estimate of the patient’s risk of complications following surgery.

“If a patient’s predicted risk of complications is high, which we’ve shown puts them at greater risk of readmission, a physician might decide to move the patient to the intensive care unit or a step-down unit after surgery, as opposed to a regular hospital unit that manages less sick patients,” said lead author Laurent G. Glance, MD. “This information could also help with staffing. Instead of taking care of eight patients, a nurse might be assigned to monitor just two or three high-risk patients in an effort to prevent complications that could lead to more hospitalizations down the road.”

Patients at high risk of complications could also be more closely monitored after they are discharged from the hospital and sent home in order to uncover and treat surgical complications earlier in their course, before patients require re-hospitalization, Glance said.

Hospital readmissions are believed to be an indicator of inferior care and are the focus of efforts by the Centers for Medicare and Medicaid Services (CMS) to reduce health care costs and to improve quality. Glance and his colleagues believe that measuring the end products of health care, such as death, complications, and re-hospitalizations, and reporting that information after the fact to health care professionals, patients, and third-party payers in the form of report cards, may not be sufficient to achieve the best possible outcomes.

“For physicians, it can be hard to know what to do with report-card data,” Glance said. “We need to provide health care teams with information they can use before, not after, complications and re-hospitalizations occur.”

Glance added that information about a patient’s likelihood of complications could be added to his or her electronic medical record and used before, during, and after surgery to help guide clinical decision-making.

This is the first study to examine the association between the risk of complications after surgery and the rate of unplanned re-hospitalizations in a large, nationally representative sample of patients undergoing general surgery. Incorporating information from the American College of Surgeons’ National Surgical Quality Improvement Program and Surgical Risk Calculator into the daily workflow of health care teams in hospitals across the country could help achieve the CMS’s goal to reduce hospital readmissions and generate savings in health care costs in the coming years, Glance said.

Source: University of Rochester Medical Center; March 6, 2014.

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