title: Medicare post-discharge deaths and readmissions following elective surgery.
abstract: BACKGROUND
  The frequency of 90-day, postdischarge deaths and readmissions in Medicare patients undergoing elective surgical procedures has not been well studied.
  
  
  METHODS
  The Medicare MedPar database for 2009 to 2010 was used to develop inpatient risk-adjusted, postoperative length-of-stay (RApoLOS) prediction models for live discharges in 21 categories of elective operations. Moving average control charts were used in each category to define RApoLOS outliers (>3σ). The relationships between RApoLOS outliers and all postdischarge deaths and readmissions within 90 days of discharge were assessed.
  
  
  RESULTS
  The inpatient mortality rate was .5%. Of 2,054,189 live discharges, 147,292 (7%) were RApoLOS outliers. There were 14,657 postdischarge deaths (.7%) and 187,566 readmissions (9%). RApoLOS outliers had a 3.5% death rate and a 17% rate of readmission, while those found not to be RApoLOS outliers had a .5% death rate and a 9% readmission rate (P < .0001).
  
  
  CONCLUSIONS
  RApoLOS outliers have increased rates of postdischarge deaths and readmissions.
authors.affiliation: Michael Pine & Associates, 1 East Wacker Drive, #1201, Chicago, IL 60601, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA. Electronic address: dfry@consultmpa.com.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: Michael Pine & Associates, 1 East Wacker Drive, #1201, Chicago, IL 60601, USA; Department of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: Michael Pine & Associates, 1 East Wacker Drive, #1201, Chicago, IL 60601, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pine
mesh_terms: D017558:Elective Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D020379:Risk Adjustment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Control charts; Elective surgical care; Hospital readmissions; Postdischarge death rates; Postoperative mortality rates; Risk-adjusted outcomes