Home E-Weekly June 21, 2016

Red Flags for Readmission

Published: June 20, 2016

When researchers study hospital readmissions after surgery, they usually look at co-morbidities or post-op complications as some of the top reasons why patients return to the hospital within 30 days of discharge. However, a range of lifestyle factors could better predict a patient's chance of readmission, according to a study appearing in JAMA Surgery.

Researchers found that issues related to substance abuse and homelessness were responsible for a larger number of readmissions than surgical complications or deteriorating medical conditions. Additionally, they found that female patients, those with diabetes or sepsis, and those insured by Medicare or Medicaid instead of commercial payers had a higher risk.

In the study, researchers looked at 173 general surgery patients who were readmitted to the hospital within 30 days of surgery, among 2,100 total discharges. They looked at both medical complications and lifestyle factors that impacted a patient's chance at readmission. They found that the most common reason for readmission, at 17%, involved patients who had been initially admitted with soft tissue infections from injection drug use that required operative drainage, and were then readmitted with new soft tissue infections at other sites.

Just over 14% of the readmissions studied involved a lack of social support. These patients may have been homeless and lacked a post-discharge telephone number, or had no way to return to the facility for follow-up appointments. Both substance abusers and those lacking social support made up nearly a third of total readmissions.

"Many cases of readmissions may truly be unavoidable in our current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the authors write. "Because interventions to reduce the risk of readmission for any group of patients can be costly and labor intensive, identification of the highest risk cohort for readmission can allow more targeted intervention for this population of socially vulnerable patients."

Kendal Gapinski

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