Variation in readmission expenditures after high-risk surgery.

Area of Science:

• Healthcare Economics
• Surgical Outcomes
• Health Services Research

Background:

• The Hospital Readmissions Reduction Program targets excess readmissions for common conditions and now includes surgical patients.
• Understanding readmission costs is crucial for managing financial implications of post-surgical care.
• High-risk surgeries represent a significant area for potential cost savings through readmission reduction.

Purpose of the Study:

• To investigate readmission intensity, measured by cost, for patients undergoing high-risk major chest and abdominal surgeries.
• To identify patient and hospital factors associated with higher readmission costs following these complex procedures.

Main Methods:

• Retrospective cohort study using the Healthcare Cost and Utilization Project State Inpatient Database (2009-2010).
• Analysis included patients undergoing major chest (e.g., aortic valve replacement, CABG) and abdominal (e.g., AAA repair, esophagectomy) surgeries.
• Multivariable logistic regression with generalized estimation equations was used to model readmission costs.

Main Results:

• Thirty-day readmission rates were 16% for major chest and 22% for major abdominal surgery.
• Discharge to a skilled nursing facility significantly increased readmission costs for both surgery types (ORs ~1.9).
• Factors like comorbidities, length of stay, and blood/imaging use predicted higher costs for chest surgery readmissions, while delayed readmission (>3 weeks) lowered costs for abdominal surgery.

Conclusions:

• Readmissions are frequent after high-risk surgery, impacting approximately 16-22% of patients.
• Predictors of elevated readmission costs are distinct for major chest versus abdominal surgeries.
• Identifying patients at risk for high readmission costs can guide interventions to reduce readmission intensity and overall healthcare expenditure.