title: Variation in surgical-readmission rates and quality of hospital care.
abstract: BACKGROUND
  Reducing hospital-readmission rates is a clinical and policy priority, but little is known about variation in rates of readmission after major surgery and whether these rates at a given hospital are related to other markers of the quality of surgical care.
  
  
  METHODS
  Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary-artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. We used bivariate and multivariate techniques to assess the relationships between readmission rates and other measures of surgical quality, including adherence to surgical process measures, procedure volume, and mortality.
  
  
  RESULTS
  For the six index procedures, there were 479,471 discharges from 3004 hospitals. The median risk-adjusted composite readmission rate at 30 days was 13.1% (interquartile range, 9.9 to 17.1). In a multivariate model adjusting for hospital characteristics, we found that hospitals in the highest quartile for surgical volume had a significantly lower composite readmission rate than hospitals in the lowest quartile (12.7% vs. 16.8%, P<0.001), and hospitals with the lowest surgical mortality rates had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3% vs. 14.2%, P<0.001). High adherence to reported surgical process measures was only marginally associated with reduced readmission rates (highest quartile vs. lowest quartile, 13.1% vs. 13.6%; P=0.02). Patterns were similar when each of the six major surgical procedures was examined individually.
  
  
  CONCLUSIONS
  Nearly one in seven patients hospitalized for a major surgical procedure is readmitted to the hospital within 30 days after discharge. Hospitals with high surgical volume and low surgical mortality have lower rates of surgical readmission than other hospitals.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Tsai
authors.forename: Karen E
authors.initials: KE
authors.lastname: Joynt
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States
references.citation: JAMA. 2010 Jul 7;304(1):95-7
references.pmid: 20606158
references.citation: Ann Surg. 2003 Aug;238(2):161-7
references.pmid: 12894006
references.citation: Arch Surg. 2009 Aug;144(8):706-12
references.pmid: 19687373
references.citation: N Engl J Med. 2005 Jul 21;353(3):265-74
references.pmid: 16034012
references.citation: Ann Surg. 2012 Oct;256(4):595-605
references.pmid: 22964736
references.citation: JAMA. 2007 Jan 3;297(1):71-6
references.pmid: 17200477
references.citation: Arch Intern Med. 2011 Jul 25;171(14):1232-7
references.pmid: 21788540
references.citation: Ann Surg. 2012 Oct;256(4):606-15
references.pmid: 22964735
references.citation: Ann Surg. 2007 Nov;246(5):875-85
references.pmid: 17968182
references.citation: Arch Surg. 2010 Nov;145(11):1039-40
references.pmid: 21079090
references.citation: JAMA. 2012 Sep 26;308(12):1227-36
references.pmid: 23011713
references.citation: N Engl J Med. 2009 Dec 31;361(27):2637-45
references.pmid: 20042755
references.citation: Am Surg. 2012 Jun;78(6):653-6
references.pmid: 22643259
references.citation: JAMA. 2011 Feb 16;305(7):675-81
references.pmid: 21325183
references.citation: Dis Colon Rectum. 2011 Nov;54(11):1362-7
references.pmid: 21979179
references.citation: J Am Coll Surg. 2012 Apr;214(4):390-8; discussion 398-9
references.pmid: 22289517
references.citation: J Am Coll Surg. 2012 Sep;215(3):322-30
references.pmid: 22726893
references.citation: Arch Intern Med. 2010 Feb 22;170(4):340-6
references.pmid: 20177036
references.citation: JAMA. 2013 Jan 23;309(4):342-3
references.pmid: 23340629
references.citation: Health Aff (Millwood). 2002 Sep-Oct;21(5):234-41
references.pmid: 12224888
references.citation: Med Care. 2011 Dec;49(12):1076-81
references.pmid: 22002649
references.citation: JAMA. 2003 Aug 13;290(6):773-80
references.pmid: 12915430
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: PLoS One. 2013 Apr 09;8(4):e59160
references.pmid: 23593133
references.citation: Circ Cardiovasc Qual Outcomes. 2011 Jan 1;4(1):53-9
references.pmid: 21156879
references.citation: J Arthroplasty. 2011 Sep;26(6 Suppl):119-23
references.pmid: 21723700