University of Washington Medical Researchers Study Readmission Rates Among Surgical Medicare Patients
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By: Saparja Nag Nov. 16, 2017
Readmission rates in the 30 days following a hospital discharge is a key metric of a hospital’s quality of healthcare. Typically, patients with chronic conditions are major contributors to readmission rates but readmissions data for surgical patients during the post-operative period are rarely studied. Three studies conducted at the University of Washington School of Medicine and Medical Center analyzed how readmissions are affected following general, urology, and thoracic oncology surgeries. Background information on government programs to reduce readmissions, how readmissions contribute to quality outcomes, and index hospital readmission rates can be found at Dexur.com.
Quality outcomes for the University of Washington Medical Center including average length of stay and 30 day readmission rates were determined from Dexur data analysis. In general, surgical hospitalizations have a longer average length of stay but a lower 30 day readmission rate than all inpatient hospitalizations. This may suggest that being slightly more conservative in the initial discharge can be beneficial in reducing readmissions. General surgery patients had a longer average length of stay than both all inpatient and all surgical hospitalizations. They also had a greater 30 day readmission rate than all surgical discharges but still a significantly lower rate than all inpatient discharges. Urology has the lowest average length of stay and 30 day readmission rate of all the categories compared. This is likely due to the fact that urology has surgical and non-surgical aspects. With procedures varying in intensity, the average length of stay and 30 day readmission rate is very low. The data can be seen in the table below.
Total Medicare Discharges and Quality Outcomes for University of Washington Medical Center by Department:
| Total Medicare Discharge - Oct 2015 to Sep 2016 | Average Length of Stay | 30 Day All Cause Readmission Rate | |
|---|---|---|---|
| All Inpatient Hospitalizations | 5663 | 6.52 | 25.62 |
| All Surgical Hospitalizations | 2689 | 7.06 | 17.96 |
| General Surgery | 902 | 7.71 | 20.62 |
| Urology | 546 | 4.88 | 17.58 |
Readmission rates to the index hospital can also be compared to evaluate quality outcomes. This metric measures what proportion of patients return to the same hospital upon readmission. Dexur data includes this value over 30 days and 90 days. For each of the four categories, the 90 day readmission rate to the index hospital decreased from the 30 day readmission rate. This trend is likely due to the fact that the further in time away a patient is from a hospital discharge, the more likely they are to be further in distance from that hospital. In the 30 days following a discharge, patients will often stay close to the hospital if possible in case they must be readmitted. The index readmission rates are comparable and significantly lower for all surgical and general surgery hospitalizations. Patients are more willing to travel to specialized facilities for surgeries. Although the majority of these readmitted patients do return to the same hospital, many patients most likely return to their homes far away from the University of Washington Medical Center after being discharged. Index hospital readmissions from 30 days to 90 days are also more constant, which can be attributed to the fact that many surgical patients live far from the hospital where they had their procedure done.
Readmission Rates to Index Hospital for University of Washington Medical Center by Department:
| 30 Day Readmission Rate to Index Hospital | 90 Day Readmission Rate to Index Hospital | |
|---|---|---|
| All Inpatient Hospitalizations | 70.37% | 65.98% |
| All Surgical Hospitalizations | 58.8% | 53.93% |
| General Surgery | 56.99% | 54.94% |
| Urology | 71.87% | 65.84% |
Medical scientists in the Department of Surgery at University of Washington Medical Center sought to understand risk factors at play for patients readmitted within 30 days of a general surgery discharge. They performed manual and statistical analysis on 2,100 patients’ medical records in order to determine if patients with certain predispositions or characteristics were more likely to be readmitted within 30 days. Although this was a relatively small sample, they found that a number of characteristics were associated with greater risk of readmission. These factors included being of the female biological sex, presence of sepsis upon admission, comorbidities like heart disease and diabetes, ICU status, and governmental payer status. Patients with Medicare or Medicaid insurance were more than twice as likely to be readmitted than those who had private insurance. These results illuminated why readmissions occur and potential interventional programs to prevent excessive readmissions.1
Another study performed in the Department of Surgery at University of Washington Medical Center specifically looked at Medicare patients who underwent surgical treatment of lung cancer. In addition to addressing 30 day readmission rates, they also analyzed other measures of healthcare utilization including prolonged length of stay (PLOS) and discharge to an institutional care facility (ICF). The cohort study from 1992 to 2002 found that of the 21,067 patients studied, 12% had PLOS, 13% had been discharged to ICFs, and 15% had been readmitted within 30 days. Patients over 80, those with higher comorbidity indices, who were not married, and who had pneumonectomies were more likely to utilize healthcare by the metrics used in this study. These patients ultimately had higher adjusted 2.5 year mortality rates than those who did not require more hospitalization.2
In the Department of Urology at the University of Washington School of Medicine, similar research was conducted. Researchers specifically looked at patients following urinary diversion procedures. They analyzed 5% of Medicare data from 1998 to 2005 for patients who had undergone any type of urinary diversion surgery to determine 90 day readmission rates. Of the 1,565 patients involved in the study, 31% had been readmitted within 90 days. These readmitted patients had higher comorbidity indices and complication rates. They were also more likely to die within 2 years of the surgery. Readmission rates included visits to the primary hospital as well as secondary medical facilities, which may affect the quality of the care.3
References:
McIntyre LK, Arbabi S, Robinson EF, et al. “Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery.” Journal of the American Medical Association. Sep 2016; 151(9):855-861.doi: 10.1001/jamasurg.2016.1258.
Farjah F, Wood DE, Varghese TK, et al. “Health care utilization among surgically treated Medicare beneficiaries with lung cancer.” Annals of Thoracic Surgery. Dec 2009; 88(6):1749-1759. doi: 10.1016/j.athoracsur.2009.08.006.
Gore JL, Lai J, Gilbert SM, et al. “Readmissions in the postoperative period following urinary diversion.” World Journal of Urology. Feb 2011; 29(1):79-84. doi: 10.1007/s00345-010-0613-8.
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