title: Outpatient follow-up versus 30-day readmission among general and vascular surgery patients: a case for redesigning transitional care.
abstract: BACKGROUND
  The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients.
  
  
  METHODS
  We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular operative procedures.
  
  
  RESULTS
  The majority of discharges for general (84% of 7,552) and vascular (75% of 2,362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2 weeks postdischarge (median, 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at 1 week (median, 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. More than one half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit.
  
  
  CONCLUSIONS
  Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications.
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Richard Scott
authors.initials: RS
authors.lastname: Saunders
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Sara
authors.initials: S
authors.lastname: Fernandes-Taylor
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Rathouz
authors.affiliation: Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Saha
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Wiseman
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Havlena
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors.forename: Jon
authors.initials: J
authors.lastname: Matsumura
authors.affiliation: Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: kent@surgery.wisc.edu.
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures