title: Hospital Readmissions after Surgery: How Important Are Hospital and Specialty Factors?
abstract: BACKGROUND
  Hospital readmission rates after surgery can represent an overall hospital effect or a combination of specialty and patient effects. We hypothesized that hospital readmission rates for procedures within specialties were more strongly correlated than rates across specialties within the same hospital.
  
  
  METHODS
  For general, orthopaedic, and vascular specialties at Veterans Affairs hospitals during 2008 to 2014, 30-day risk-adjusted readmission rates were estimated for 6 high-volume procedures and each specialty. Relationships were assessed using the Pearson correlation coefficient.
  
  
  RESULTS
  At 84 hospitals, 64,724 orthopaedic, 24,963 general, and 10,399 vascular inpatient procedures were performed; mean readmission rates were 6.3%, 13.6%, and 16.4%, respectively. There was no correlation between specialty-specific adjusted hospital readmission rates: general and orthopaedic (r = 0.21; p = 0.06), general and vascular (r = 0.15; p = 0.19), and vascular and orthopaedic surgery (r = 0.07; p = 0.55). Within specialties, we found modest correlations between knee and hip arthroplasty readmission rates (r = 0.39; p < 0.01) and colectomy and ventral hernia repair (r = 0.24; p = 0.03), but not between lower-extremity bypass and endovascular aortic repair (r = 0.13; p = 0.26). Overall, controlling for patient-level factors, 1.9% of the variation in readmissions was attributable to specialty-level factors; only 0.6% was attributable to hospital-level factors.
  
  
  CONCLUSIONS
  Hospital readmission rates for orthopaedic, vascular, and general surgery were not correlated between specialties; within each of the 3 specialties, modest correlations were found between 2 procedures within 2 of these specialties. These findings suggest that hospital surgical readmission rates are primarily explained by patient- and procedure-specific factors and less by broader specialty and/or hospital effects.
authors.affiliation: Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hollis
authors.affiliation: Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.affiliation: Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.affiliation: Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Morris
authors.affiliation: Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston University School of Medicine, Boston, MA.
authors.forename: Hillary J
authors.initials: HJ
authors.lastname: Mull
authors.affiliation: Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham VA Medical Center, Birmingham, AL; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Tyler S
authors.initials: TS
authors.lastname: Wahl
authors.affiliation: Milwaukee Veterans Affairs Medical Center, Milwaukee, WI.
authors.forename: Edith
authors.initials: E
authors.lastname: Burns
authors.affiliation: Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA; Baylor Scott & White Health, Center for Applied Health Research, Temple, TX; Texas A&M Health Science Center, College of Medicine, Temple, TX.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: Milwaukee Veterans Affairs Medical Center, Milwaukee, WI; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Telford
authors.affiliation: Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston University School of Medicine, Boston, MA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.affiliation: Veterans Affairs Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Surgery, Boston University School of Medicine, Boston, MA; Harvard University School of Medicine, Boston, MA.
authors.forename: Kamal F
authors.initials: KF
authors.lastname: Itani
authors.affiliation: Milwaukee Veterans Affairs Medical Center, Milwaukee, WI.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Whittle
authors.affiliation: Veterans Affairs, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Veterans Affairs, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA. Electronic address: mhawn@stanford.edu.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D014481:United States