title: Hospital readmission after noncardiac surgery: the role of major complications.
abstract: OBJECTIVE
  Hospital readmissions are believed to be an indicator of suboptimal care and are the focus of efforts by the Centers for Medicare and Medicaid Services to reduce health care cost and improve quality. Strategies to reduce surgical readmissions may be most effective if applied prospectively to patients who are at increased risk for readmission. Hospitals do not currently have the means to identify surgical patients who are at high risk for unplanned rehospitalizations.
  
  
  OBJECTIVE
  To examine whether the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicted risk of major complications can be used to identify surgical patients at risk for rehospitalization.
  
  
  METHODS
  Retrospective cohort study of 142,232 admissions in the ACS NSQIP registry for major noncardiac surgery.
  
  
  METHODS
  The association between unplanned 30-day readmission and the ACS NSQIP predicted risk of major complications, controlling for severity of disease and surgical complexity.
  
  
  RESULTS
  Of the 143,232 patients undergoing noncardiac surgery, 6.8% had unplanned 30-day readmissions. The rate of unplanned 30-day readmissions was 78.3% for patients with any postdischarge complication, compared with 12.3% for patients with only in-hospital complications and 4.8% for patients without any complications. Patients at very high risk for major complications (predicted risk of ACS NSQIP complication >10%) had 10-fold higher odds of readmission compared with patients at very low risk for complications (adjusted odds ratio = 10.35; 95% CI, 9.16-11.70), whereas patients at high (adjusted odds ratio = 6.57; 95% CI, 5.89-7.34) and moderate (adjusted odds ratio = 3.96; 95% CI, 3.57-4.39) risk of complications had 7- and 4-fold higher odds of readmission, respectively.
  
  
  CONCLUSIONS
  Unplanned readmissions in surgical patients are common in patients experiencing postoperative complications and can be predicted using the ACS NSQIP risk of major complications. Prospective identification of high-risk patients, using the NSQIP complication risk index, may allow hospitals to reduce unplanned rehospitalizations.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Kellermann
authors.forename: Turner M
authors.initials: TM
authors.lastname: Osler
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Lustik
authors.forename: Michael P
authors.initials: MP
authors.lastname: Eaton
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States