Variation in postacute care utilization after complex surgery

Area of Science:

• Health Services Research
• Surgical Outcomes
• Healthcare Policy

Background:

• Postacute care (PAC) utilization drives significant regional variation in Medicare spending.
• Previous studies on hospital PAC variation focused on non-surgical patients or limited datasets.
• Nationally representative data on postoperative PAC discharge variation between hospitals is lacking.

Purpose of the Study:

• To investigate hospital-level variations in postacute care utilization following cardiovascular and abdominal surgery.
• To provide a national perspective on discharge patterns to skilled nursing facilities and inpatient rehabilitation.

Main Methods:

• Analysis of 3,487,365 non-veteran and 60,666 veteran patients undergoing major surgeries (colorectal, hepatectomy, pancreatectomy, coronary bypass, aortic repair, vascular bypass) from 2008-2011.
• Calculation of unadjusted and risk-adjusted observed-to-expected ratios for PAC discharge at the hospital level.
• Inclusion of data from the Nationwide Inpatient Sample and Veterans Affairs health system.

Main Results:

• 18% of non-veterans and 8% of veterans were discharged to PAC facilities.
• Hospital discharge rates to PAC varied widely: 1%-36% for veteran hospitals and 1%-59% for non-veteran hospitals.
• Risk-adjusted ratios indicated substantial hospital-level variation in PAC utilization.

Conclusions:

• Significant variation exists in postacute care utilization and home discharge rates after major abdominal and cardiovascular surgeries.
• Further research is necessary to identify health system factors contributing to PAC utilization variability.
• Addressing these variations may lead to more standardized and potentially cost-effective patient care pathways.