Patients who suffer post-discharge surgical complications are more likely to be readmitted than those whose complications occur during hospitalization, according to a study in JAMA Surgery, which suggests discharge is an insufficient endpoint for the quality assessment of care.
The review of nearly 60,000 records of patients who underwent colorectal, arthroplasty, vascular and gynecologic surgeries at 112 Veterans Affairs hospitals between January 2005 and August 2009 shows 22.6% of the cases involved pre- or post-discharge complications. Overall, 11.9% of patients were readmitted at 30 days post-op, although only a little more than half were associated with a complication measured by the Veterans Affairs Surgical Quality Improvement Program, which supplied the study's data.
Notably, although approximately 70% of complications were identified before discharge, more than a quarter of the adverse events did not occur until after patients left the hospital. Surgical site infections accounted for more than half of post-discharge complications that led to readmissions, the highest rate noted in the study.
Efforts to prevent surgical readmissions must start with patient education during initial assessments and should include coordinated post-discharge care, notes an accompanying commentary. The authors say improvements can be made to existing protocols instead of creating new practices centered on limiting readmissions.
For example, say the authors, surgical site infections after colon surgery can be prevented with the proper administration of prophylactic antibiotics and the maintenance of normothermia, 2 recommendations of the Surgical Care Improvement Project. "Emerging evidence suggests that although we do follow SCIP guidelines, we certainly have room to improve," they write.