title: Assessing readmission after general, vascular, and thoracic surgery using ACS-NSQIP.
abstract: OBJECTIVE
  In 2012, Medicare began cutting reimbursement for hospitals with high readmission rates. We sought to define the incidence and risk factors associated with readmission after surgery.
  
  
  METHODS
  A total of 230,864 patients discharged after general, upper gastrointestinal (GI), small and large intestine, hepatopancreatobiliary (HPB), vascular, and thoracic surgery were identified using the 2011 American College of Surgeons National Surgical Quality Improvement Program. Readmission rates and patient characteristics were analyzed. A predictive model for readmission was developed among patients with length of stay (LOS) 10 days or fewer and then validated using separate samples.
  
  
  RESULTS
  Median patient age was 56 years; 43% were male, and median American Society of Anesthesiologists (ASA) class was 2 (general surgery: 2; upper GI: 3; small and large intestine: 2; HPB: 3; vascular: 3; thoracic: 3; P < 0.001). The median LOS was 1 day (general surgery: 0; upper GI: 2; small and large intestine: 5; HPB: 6; vascular: 2; thoracic: 4; P < 0.001). Overall 30-day readmission was 7.8% (general surgery: 5.0%; upper GI: 6.9%; small and large intestine: 12.6%; HPB: 15.8%; vascular: 11.9%; thoracic: 11.1%; P < 0.001). Factors strongly associated with readmission included ASA class, albumin less than 3.5, diabetes, inpatient complications, nonelective surgery, discharge to a facility, and the LOS (all P < 0.001). On multivariate analysis, ASA class and the LOS remained most strongly associated with readmission. A simple integer-based score using ASA class and the LOS predicted risk of readmission (area under the receiver operator curve 0.702).
  
  
  CONCLUSIONS
  Readmission among patients with the LOS 10 days or fewer occurs at an incidence of at least 5% to 16% across surgical subspecialties. A scoring system on the basis of ASA class and the LOS may help stratify readmission risk to target interventions.
authors.affiliation: *Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD †Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Surgery, Emory Hospital, Atlanta, GA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Lucas
authors.forename: Adil
authors.initials: A
authors.lastname: Haider
authors.forename: Elliot
authors.initials: E
authors.lastname: Haut
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dodson
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
authors.forename: John
authors.initials: J
authors.lastname: Sweeney
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D019616:Thoracic Surgical Procedures; D014481:United States; D014656:Vascular Surgical Procedures
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