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08.01.2019 | Original Article | Ausgabe 8/2019

Journal of Gastrointestinal Surgery 8/2019

Complete Impact of Care Fragmentation on Readmissions Following Urgent Abdominal Operations

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 8/2019
Autoren:
Yen-Yi Juo, Yas Sanaiha, Usah Khrucharoen, Areti Tillou, Erik Dutson, Peyman Benharash
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11605-018-4033-1) contains supplementary material, which is available to authorized users.

Meeting Presentations

Podium presentation at the 89th Pacific Coast Surgical Association Annual Meeting on February 17, 2018, in Napa, CA

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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.

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Zusatzmaterial
ESM 1 (DOCX 26 kb)
11605_2018_4033_MOESM1_ESM.docx
Literatur
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