title: Hospital readmission after multiple major operative procedures among patients with employer provided health insurance.
abstract: Most studies report data only on readmission within 30 days of discharge from the same hospital following a single procedure. We sought to define the incidence of early versus late hospital readmission among patients undergoing multiple major operative procedures.
  
  
  
  Patients were identified using the MarketScan database from 2010-2012. Multivariable logistic regression analysis was performed to identify factors associated with early (≤30 days) versus late readmission (31-90 days) among patients who underwent multiple operative procedures.
  
  
  
  A total of 194,111 patients were identified of whom 63.2% (n = 122,660) underwent an abdominal procedure (esophagectomy, pancreatectomy, hepatectomy, colectomy, lung resection, and gastrectomy), while the remaining 71,451 (36.8%) patients underwent a cardiovascular procedure (repair of abdominal aortic aneurysm, coronary-artery bypass grafting, carotid endarterectomy, and mitral/aortic valve replacement). A total of 3,444 patients underwent >1 simultaneous procedure (abdominal: 885, 0.7%; cardiovascular: 2,559, 3.6%). The overall incidence of 90-day readmission was 15.6% (n = 30,309); 9.6% of patients were readmitted early, while 6.0% of patients were readmitted late. Readmission was higher among patients undergoing multiple procedures (21.8% vs 15.5%; P < .001). On multivariable analysis, patients undergoing multiple operative procedures demonstrated a 20% greater odds of readmission compared with patients undergoing a single operative procedure (abdominal: odds ratio 1.18, 95% confidence interval 1.01-1.37; P = .03; cardiovascular: odds ratio 1.18, 95% confidence interval 1.06-1.31; P = .002). Other risk factors independently associated with increased odds for early and late readmission included a higher preoperative comorbidity, postoperative discharge with additional care, an increasing duration of stay, and the development of postoperative complications (all P < .05).
  
  
  
  Readmission following a major operation is common, with >15% of patients being readmitted within 90 days of index discharge. Compared with patients undergoing a single operative procedure, patients undergoing multiple operative procedures demonstrated an increased risk for readmission within 90 days of discharge and were more likely to be readmitted within 30 days of index discharge.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Canner
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Georgios A
authors.initials: GA
authors.lastname: Margonis
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Makary
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D013504:Cardiovascular Surgical Procedures; D013505:Digestive System Surgical Procedures; D005260:Female; D006264:Health Benefit Plans, Employee; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D055815:Young Adult