Yen-Yi Juo1,2, Yas Sanaiha1,2, Usah Khrucharoen2, Areti Tillou2, Erik Dutson2, Peyman Benharash3,4,5. 1. Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA. 2. Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA. 3. Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA. Pbenharash@mednet.ucla.edu. 4. Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA. Pbenharash@mednet.ucla.edu. 5. UCLA Division of Cardiac Surgery, UCLA Center for Health Sciences, 10833 Le Conte Avenue, Room 62-249, Los Angeles, CA, 90095, USA. Pbenharash@mednet.ucla.edu.
Abstract
BACKGROUND: Urgent abdominal operations commonly occurred in low-volume hospitals with high failure-to-rescue rates. Recent studies have demonstrated a survival benefit associated with readmission to the original hospital after operation, presumably due to improved continuity of care. It is unclear if this survival benefit persists in low-volume hospitals. We seek to evaluate differences in mortality between readmission to the original hospital and a higher-volume hospital after urgent abdominal operations. METHODS: A retrospective cohort study using the National Readmissions Database from 2010 to 2014 was performed. Propensity score-weighted multilevel regression analysis was used to examine the association between readmission destination and mortality after accounting for hospital volume. RESULTS: A total of 71,551 adult patients who experienced 30-day readmission following urgent abdominal operations were identified, among whom 10,368 (14.5%) were readmitted to a different hospital. Patients with higher baseline comorbidity scores, lower income, less comprehensive insurance coverage, systemic complications, prolonged length of stay, or non-home disposition were more likely to experience readmission to a different hospital. Following stratification by readmission hospital volume and propensity score weighting to adjust for baseline mortality risk differences, readmission to a different hospital is still associated with higher mortality rates than the original hospital. CONCLUSIONS: The adverse outcomes associated with case fragmentation are present even after adjusting for readmission hospital volume. Patients who received urgent abdominal operations at low-volume hospitals should return to the original hospital for concern of care fragmentation.
BACKGROUND: Urgent abdominal operations commonly occurred in low-volume hospitals with high failure-to-rescue rates. Recent studies have demonstrated a survival benefit associated with readmission to the original hospital after operation, presumably due to improved continuity of care. It is unclear if this survival benefit persists in low-volume hospitals. We seek to evaluate differences in mortality between readmission to the original hospital and a higher-volume hospital after urgent abdominal operations. METHODS: A retrospective cohort study using the National Readmissions Database from 2010 to 2014 was performed. Propensity score-weighted multilevel regression analysis was used to examine the association between readmission destination and mortality after accounting for hospital volume. RESULTS: A total of 71,551 adult patients who experienced 30-day readmission following urgent abdominal operations were identified, among whom 10,368 (14.5%) were readmitted to a different hospital. Patients with higher baseline comorbidity scores, lower income, less comprehensive insurance coverage, systemic complications, prolonged length of stay, or non-home disposition were more likely to experience readmission to a different hospital. Following stratification by readmission hospital volume and propensity score weighting to adjust for baseline mortality risk differences, readmission to a different hospital is still associated with higher mortality rates than the original hospital. CONCLUSIONS: The adverse outcomes associated with case fragmentation are present even after adjusting for readmission hospital volume. Patients who received urgent abdominal operations at low-volume hospitals should return to the original hospital for concern of care fragmentation.
Entities:
Keywords:
Abdominal surgery; Care discontinuity; Care fragmentation; Readmission
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