A Hidden Cause of Readmissions Comes to Light

Cheryl Clark, February 13, 2014

Serious complications resulting from surgery are only now attracting attention as a cause for hospital readmissions. That may be because some surgeries will soon be included in Medicare's 3% readmissions penalty algorithm.

Amidst all the frenzy to prevent 30-day readmissions, some hospital teams may be surprised to learn that they've been neglecting an important and apparently hidden source of these preventable costs.

That source of readmissions is serious complications from surgery.

And it is only now attracting attention, perhaps some surgeries are now included in the 3% readmissions penalty algorithm, and more are anticipated.

A report out this week shows a surprisingly high number of surgical patients developing these complications, such as a venous thromboembolism (VTE) or infection, after discharge. Many of these patients require a return to the hospital for life-saving and expensive care, researchers at the University of Alabama Birmingham have discovered.

Such complications are known and reported, but the focus has been mainly on complications discovered during the initial hospital stay.

"The thing that surprised us most was the proportion of complications that were happening after the hospitalization," a large share of which resulted in the patient's return, explains Mary Hawn, chief of gastrointestinal surgery at the University of Alabama Birmingham and the senior author of the report, published online in Wednesday's JAMA Surgery.

"If we're just using the end of the index hospitalization to assess our rates of complications, we're going to miss a lot of these complications that are likely attributable to that surgical procedure," she says.

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