Austin J Lee1, Xiang Liu2, Tudor Borza3, Yongmei Qin4, Benjamin Y Li4, Kenneth L Urish5, Peter S Kirk4, Scott Gilbert6, Brent K Hollenbeck3, Jonathan E Helm7, Mariel S Lavieri2, Ted A Skolarus8, Bruce L Jacobs9. 1. School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: ajl97@pitt.edu. 2. Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan. 3. Divisions of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Divisions of Health Services Research and Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan. 4. Divisions of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan. 5. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 6. Department of Urology, H. Lee Moffitt Cancer Center, Tampa, Florida. 7. W.P. Carey School of Business, Arizona State University, Tempe, Arizona. 8. Divisions of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Divisions of Health Services Research and Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Tempe, Arizona. 9. Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Payment models, including the Hospital Readmissions Reduction Program and bundled payments, place pressures on hospitals to limit readmissions. Against this backdrop, we sought to investigate the association of post-acute care after major surgery and readmission rates. METHODS: We identified patients undergoing high-risk surgery (abdominal aortic aneurysm repair, coronary bypass grafting, aortic valve replacement, carotid endarterectomy, esophagectomy, pancreatectomy, lung resection, and cystectomy) from 2005 to 2010 using the Healthcare Cost and Utilization Project's State Inpatient Database. The primary outcome was readmission rates after major surgery. Secondary outcome was readmission length of stay. RESULTS: We identified 135,523 patients of whom 56,720 (42%) received post-acute care. Patients receiving post-acute care had higher readmission rates than those who were discharged home (16% versus 10%, respectively; P < 0.001). The risk-adjusted readmission length of stay was greatest for patients who received care from a skilled nursing facility, followed by those who received home care, and lowest for those who did not receive post-acute care (7.1 versus 5.4 versus 4.8 d, respectively; P < 0.001). CONCLUSIONS: The use of post-acute care was associated with higher readmission rates and higher readmission lengths of stay. Improving the support of patients in post-acute care settings may help reduce readmissions and readmission intensity.
BACKGROUND: Payment models, including the Hospital Readmissions Reduction Program and bundled payments, place pressures on hospitals to limit readmissions. Against this backdrop, we sought to investigate the association of post-acute care after major surgery and readmission rates. METHODS: We identified patients undergoing high-risk surgery (abdominal aortic aneurysm repair, coronary bypass grafting, aortic valve replacement, carotid endarterectomy, esophagectomy, pancreatectomy, lung resection, and cystectomy) from 2005 to 2010 using the Healthcare Cost and Utilization Project's State Inpatient Database. The primary outcome was readmission rates after major surgery. Secondary outcome was readmission length of stay. RESULTS: We identified 135,523 patients of whom 56,720 (42%) received post-acute care. Patients receiving post-acute care had higher readmission rates than those who were discharged home (16% versus 10%, respectively; P < 0.001). The risk-adjusted readmission length of stay was greatest for patients who received care from a skilled nursing facility, followed by those who received home care, and lowest for those who did not receive post-acute care (7.1 versus 5.4 versus 4.8 d, respectively; P < 0.001). CONCLUSIONS: The use of post-acute care was associated with higher readmission rates and higher readmission lengths of stay. Improving the support of patients in post-acute care settings may help reduce readmissions and readmission intensity.
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