Richard Scott Saunders1, Sara Fernandes-Taylor1, Paul J Rathouz2, Sandeep Saha2, Jason T Wiseman1, Jeffrey Havlena1, Jon Matsumura1, K Craig Kent3. 1. Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 3. Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address: kent@surgery.wisc.edu.
Abstract
BACKGROUND: The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. METHODS: We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular operative procedures. RESULTS: The majority of discharges for general (84% of 7,552) and vascular (75% of 2,362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2 weeks postdischarge (median, 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at 1 week (median, 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. More than one half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. CONCLUSION: Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications.
BACKGROUND: The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. METHODS: We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular operative procedures. RESULTS: The majority of discharges for general (84% of 7,552) and vascular (75% of 2,362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2 weeks postdischarge (median, 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at 1 week (median, 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. More than one half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. CONCLUSION: Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications.
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