title: Impact of Post-Hospital Syndrome on Outcomes Following Elective, Ambulatory Surgery.
abstract: The aim of this study was to investigate whether post-hospital syndrome (PHS) places patients undergoing elective hernia repair at increased risk for adverse postoperative events.
  
  
  
  PHS is a transient period of health vulnerability following inpatient hospitalization for acute illness. PHS has been well studied in nonsurgical populations, but its effect on surgical outcomes is unclear.
  
  
  
  State-specific datasets for California in 2011 available through the Healthcare Cost and Utilization Project (HCUP) were linked. Patients older than 18 years who underwent elective hernia repair were included. The primary exposure variable was PHS, defined as any inpatient admission within 90 days of an elective hernia repair performed in an ambulatory surgery center. The primary outcome was an adverse event, defined as any unplanned emergency department visit or inpatient admission within 30 days postoperatively. Mixed-effects logistic models were used for multivariable analyses.
  
  
  
  A total of 57,988 patients met inclusion criteria. The 30-day risk-adjusted adverse event rate was significantly higher for PHS patients versus non-PHS patients (11.8% vs 5.8%, P < 0.001). PHS patients were more likely than non-PHS patients to experience postoperative complications (odds ratio 2.2, 95% confidence interval 1.6-3.0). Adverse events attributable to PHS cost an additional $63,533.46 per 100 cases in California. The risk of adverse events due to PHS remained elevated throughout the 90-day window between hospitalization and surgery.
  
  
  
  Patients hospitalized within 90 days of an elective surgery are at increased risk of adverse events postoperatively. The impact of PHS on outcomes is independent of baseline patient characteristics, medical comorbidities, quality of center performing the surgery, and reason for hospitalization before elective surgery. Adverse events owing to PHS are costly and represent a quality improvement target.
authors.affiliation: *Loyola University Medical Center, One:MAP Division of Clinical Informatics and Analytics, Maywood, IL †Loyola University Medical Center, Department of Urology, Maywood, IL ‡Loyola University Chicago, Department of Public Health Sciences, Maywood, IL §Loyola University Medical Center, Department of Surgery, Maywood, IL.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Brownlee
authors.forename: Robert H
authors.initials: RH
authors.lastname: Blackwell
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Blanco
authors.forename: Matthew A C
authors.initials: MAC
authors.lastname: Zapf
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kliethermes
authors.forename: Gopal N
authors.initials: GN
authors.lastname: Gupta
authors.forename: Paul C
authors.initials: PC
authors.lastname: Kuo
authors.forename: Anai N
authors.initials: AN
authors.lastname: Kothari
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D059685:Herniorrhaphy / Q000009:adverse effects*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013577:Syndrome