title: The role of the hospital and health care system characteristics in readmissions after major surgery in California.
abstract: BACKGROUND
  Hospital readmission after major surgery is a costly problem that has been associated with patient characteristics. Because hospitals are incentivized to join accountable care organizations, interventions on a hospital or health care system level may help reduce readmissions. Our objective was to identify hospital- and systems-level characteristics associated with readmissions after major operative procedures.
  
  
  METHODS
  Retrospective analysis of California discharge abstracts with record linkage numbers for adult patients undergoing coronary artery bypass graft (CABG), colectomy or total hip/knee arthroplasty (TJA) in California acute, nonfederal hospitals in 2011. The record linkage number showed where patients were readmitted. Hierarchic logistic regression estimated the odds of readmission by hospital characteristics.
  
  
  RESULTS
  There were 91,205 records analyzed: CABG (6.4%), colectomy (12.0%), and TJA (82.3%). There were 120 hospitals that performed CABG surgery; 296 performed colectomy; and 298 performed TJA. Readmission rates after CABG was 9.7%, colectomy 7.7%, and TJA 3.9%. After adjustment for patient factors, rural location was predictive of readmission after colectomy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.40-3.08). Low-volume (OR 1.54, 95% CI 1.13-2.10) and minority-serving hospitals (OR 1.18, 95% CI 1.05-1.33) were associated with greater odds of readmission after TJA.
  
  
  CONCLUSIONS
  Select hospital characteristics are associated with readmissions after major operative procedures. Because financial penalties may worsen performance in vulnerable or low-resource settings, policies aimed at reducing readmissions should be attentive to the potential unintended consequences.
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA. Electronic address: joy.chen@stanford.edu.
authors.forename: Joy C
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Shaw
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003082:Colectomy; D001026:Coronary Artery Bypass; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors