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A composite index for predicting readmission following emergency general surgery
Gajanthan Muthuvel1, Sarah E Tevis, Amy E Liepert
1From the Department of Surgery (S.E.T., A.E.L., S.K.A., G.D.K.), School of Medicineand Public Health (G.M.), University of Wisconsin, Madison, Wisconsin.
The Journal of Trauma and Acute Care Surgery
|May 24, 2014
Summary
Emergency surgery patients have a higher readmission rate. The Surgical Apgar Score (SAS) and ASA/LOS predict 30-day readmission risk in this population.
Area of Science:
- Surgical outcomes research
- Patient safety and quality improvement
- Health services research
Background:
- Preventable hospital readmissions are a significant concern nationally.
- Emergency general surgery patients face unique challenges regarding readmission.
- Predictive factors for readmission in emergent surgical populations are not well-established.
Purpose of the Study:
- To characterize 30-day readmission rates in emergent general surgery.
- To identify readily available variables that predict readmission risk.
- To test the hypothesis that the Surgical Apgar Score (SAS) correlates with readmission risk.
Main Methods:
- Retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program database and electronic medical records.
- Inclusion of adult general surgery patients undergoing emergency procedures from 2006 to 2012.
- Univariate and multivariate analyses to identify factors associated with 30-day readmission.
Main Results:
- Emergency surgery patients exhibited a higher readmission rate (15.2%) compared to non-emergency patients (11.1%).
- The Surgical Apgar Score (SAS) was significantly associated with elevated readmission risk (OR, 3.297; p = 0.037).
- Combined American Society of Anesthesiologists Physical Status Classification and length of stay also predicted increased readmission risk (OR, 4.370; p < 0.001).
Conclusions:
- Readily available measures, including SAS and ASA/LOS, can stratify emergency general surgery patients by readmission risk.
- This risk stratification facilitates the development of targeted interventions to reduce unplanned readmissions.
- The findings support proactive strategies for improving outcomes in emergent surgical care.
