Readmission after major surgery: effect of the postdischarge environment.
Although uncoordinated postdischarge care has been associated with poor clinical outcomes, the effect of discharge to a low healthcare resource area (LHRA) on readmission remains undetermined. We sought to assess how the quality of discharge area health resources impact readmission following major surgery.



This cross-sectional study was performed by linking Maryland state data for 2012-2015 to the Agency for Healthcare Research and Quality Area Health-Resource File. Patients undergoing one of 11 common surgical procedures were identified. Multivariable logistic regression was performed to assess the effect of discharge area health resource quality on readmission.



A total of 76,747 patients were identified of which 9.4% were discharged to a high healthcare resource area (HHRA), whereas 81.9% of patients were discharged to an LHRA. Perioperative morbidity and length of stay were comparable between HHRA versus LHRA patients (both P > 0.05). Among all patients, 30-d and 90-d readmission was 6.5% and 12.4%, respectively. On multivariable analysis, discharge to LHRA was independently associated with a 19% (odds ratio = 1.19; 95% CI, 1.01-1.41; P = 0.043) and 18% (odds ratio = 1.18; 95% CI, 1.04-1.33; P = 0.010) greater odds of 30-d and 90-day readmission, respectively.



Patients discharged to an area characterized by LHRA were more likely to be readmitted at 30 d and 90 d following index discharge.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Marcelo
M
Cerullo
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Faiz
F
Gani
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sophia Y
SY
Chen
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Joseph K
JK
Canner
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: tpawlik1@jhmi.edu.
Timothy M
TM
Pawlik
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006295:Health Resources / Q000592:standards*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative
Postdischarge care; Readmission; Surgical complications