title: Reasons for 30-day postoperative readmissions for Medicare patients at a community-based teaching hospital.
abstract: Healthcare reform initiatives have proposed reducing reimbursement for certain 30-day readmissions among Medicare patients. Our objective was to evaluate the incidence and reasons for 30-day postoperative readmissions at our institution. The medical records of Medicare patients who underwent surgery from January 1, 2010, through May 16, 2011, were reviewed. Statistical analysis included χ(2), Wilcoxon rank sum, and t tests. Two thousand eight hundred sixty-five patients were included; 199 (7%) had a 30-day readmission. The readmission group included a higher proportion of men (53.8 vs 43.6%, P = 0.005), and patients with an American Society of Anesthesiologists (ASA) Class 3 or greater (84 vs 66%, P < 0.001) versus the nonreadmission group. Mean index length of stay and operative time were longer in the readmitted versus nonreadmitted group (4.8 vs 2.8 days, P < 0.001; 122.8 vs 98.2 minutes, P < 0.001). Readmission reasons were surgically related (53%), surgically unrelated (35%), planned (7%), and patient-related (5%). Higher 30-day postoperative readmission rates were associated with male sex, higher ASA class, and longer index length of stay and operative time. Reasons for readmission included surgical- and patient-related factors. Decreased reimbursement should be discouraged for readmissions directly related to patient noncompliance.
authors.affiliation: Department of Anesthesiology, Gundersen Health System, La Crosse, Wisconsin, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kirsch
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
authors.forename: Janelle M
authors.initials: JM
authors.lastname: Ausloos
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Gundrum
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000191:economics*; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000191:economics*; D010351:Patient Discharge / Q000191:economics / Q000639:trends; D010359:Patient Readmission / Q000191:economics* / Q000639:trends; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology