title: Descriptive analysis of 30-day readmission after inpatient surgery discharge in the Veterans Health Administration.
abstract: OBJECTIVE
  For the first time to our knowledge, this study analyzes and reports the 30-day all-cause readmission rates for surgical procedures performed in the Veterans Health Administration (VHA).
  
  
  OBJECTIVE
  To analyze and report 30-day all-cause readmission rates following discharge from 9 surgical specialties in the VHA for a 10-year period.
  
  
  METHODS
  In a retrospective observational study, Veterans Affairs Surgical Quality Improvement Program data for surgery records and VHA administrative discharge data were linked to evaluate all-cause readmission within 30 days of discharge from the surgical inpatient stay. The study population represents 9 surgical specialty groups: general, urology, neurosurgery, orthopedic, otolaryngology, plastic, thoracic, peripheral vascular, and cardiac. Trends of postoperative hospital admission rates for each surgery were investigated using 10 years (fiscal years 2001-2010; N = 894,943) of linked data.
  
  
  METHODS
  All-cause 30-day readmission after surgery for each specialty.
  
  
  RESULTS
  During the 10-year period, the overall 30-day all-cause readmission rate following inpatient surgery discharge significantly decreased from 12.9% to 12.2% (P < .001). Unadjusted readmission rates varied by surgical specialty: general, 12.5%; urology, 9.0%; neurosurgery, 10.5%; orthopedic, 9.6%; otolaryngology, 9.5%; plastic, 12.2%; thoracic, 14.4%; peripheral vascular, 16.0%; and cardiac, 16.6%. The following specialties were found to have a significant decline in readmission rates: orthopedic (P = .004), otolaryngology (P = .005), plastic (P = .02), thoracic (P = .04), peripheral vascular (P < .001), and cardiac (P = .003). Postoperative hospital length of stay in individual specialties decreased during this period (each P < .05) except for thoracic and cardiac surgery, which remained unchanged. Readmission diagnoses varied by specialty; postoperative infection was the most common readmission diagnosis in 7 specialties and the second most common in the other 2 specialties (urology and thoracic). Urinary tract infection and digestive system complications were also common readmission diagnoses.
  
  
  CONCLUSIONS
  This retrospective observational study showed decreasing 30-day readmission rates associated with a decline in postoperative hospital length of stay for 9 surgical specialties in the VHA during a 10-year period. Further study will be required to capture data from patients who had surgery at a VHA facility but were readmitted in the private sector.
authors.affiliation: Veterans Affairs National Surgery Office, Denver, Colorado.
authors.forename: Soonhee
authors.initials: S
authors.lastname: Han
authors.affiliation: Veterans Affairs National Surgery Office, Denver, Colorado.
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Smith
authors.affiliation: Veterans Health Administration, Washington, DC3The George Washington University, Washington, DC.
authors.forename: William
authors.initials: W
authors.lastname: Gunnar
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D015331:Cohort Studies; D003681:Dehydration / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009369:Neoplasms / Q000145:classification / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology*; D012189:Retrospective Studies; D017678:Sex Distribution; D013503:Surgery Department, Hospital / Q000145:classification / Q000706:statistics & numerical data*; D013530:Surgical Wound Infection / Q000453:epidemiology; D014481:United States