title: Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab.
abstract: OBJECTIVE
  To prospectively evaluate predictive factors of hospital readmission rates in patients undergoing abdominal surgical procedures.
  
  
  BACKGROUND
  Recommendations from MedPAC that the Centers for Medicare and Medicaid Services (CMS) report upon and determine payments based in part on readmission rates have led to an attendant interest by payers, hospital administrators and far-sighted physicians.
  
  
  METHODS
  Analysis of 266 prospective treated patients undergoing major abdominal surgical procedures from September 2009 to September 2010. All patients were prospectively evaluated for underlying comorbidities, number of preop meds, surgical procedure, incision type, complications, presence or absence of primary and/or secondary caregiver, their education level, discharge number of medications, and discharge location. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Two hundred twenty-six patients were reviewed with 48 (18%) gastric-esophageal, 39(14%) gastrointestinal, 88 (34%) liver, 58 (22%) pancreas, and 33 (12%) other. Seventy-eight (30%) were readmitted for various diagnoses the most common being dehydration (26%). Certain preoperative and intraoperative factors were not found to be significant for readmission being, comorbidities, diagnosis, number of preoperative medications, patient education level, type of operation, blood loss, and complications. Significant predictive factors for readmission were age (≥69 years), number of discharged (DC) meds (≥9 medications), ≤50% oral intake (52% vs. 23%), and DC home with a home health agency (62% vs. 11%)
  
  
  CONCLUSIONS
  Readmission rates for surgeons WILL become a quality indicator of performance. Quality parameters among Home Health agencies are nonexistent, but will reflect on surgeon’s performance. Greater awareness regarding predictors of readmission rates is necessary to demonstrate improved surgical quality.
authors: Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA.
authors: Robert C G
authors: RC
authors: Martin
authors: Russell
authors: R
authors: Brown
authors: Lisa
authors: L
authors: Puffer
authors: Stacey
authors: S
authors: Block
authors: Glenda
authors: G
authors: Callender
authors: Amy
authors: A
authors: Quillo
authors: Charles R
authors: CR
authors: Scoggins
authors: Kelly M
authors: KM
authors: McMasters
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D013502:General Surgery; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010819:Physician's Role; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000534:rehabilitation; D055815:Young Adult