title: Understanding recurrent readmission after major surgery among patients with employer-provided health insurance.
abstract: BACKGROUND
  Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery.
  
  
  METHODS
  A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured.
  
  
  RESULTS
  Median patient age was 55 years, and a slight majority (55.4%) was male. Comorbidities were common as 36.9% had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8%) patients who experienced readmission, 64.0% experienced 1 readmission, whereas 36.0% experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3% vs 44.2%) and have more comorbidities (Charlson comorbidity index ≥2, 49.5% vs 42.5%; both P < .001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5% vs 30.7%, P < .001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P < .001). Among study cohort, 4.5% experienced 3 or more readmissions; these patients accounted for 14.8% of all admissions and 13.7% of hospital charges for the study cohort during the entire follow-up period.
  
  
  CONCLUSIONS
  Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5% of patients with ≥3 readmissions accounted for 14.8% of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Gani
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Canner
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006264:Health Benefit Plans, Employee; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Outcomes; Readmission; Recurrent readmission; Surgery