Risk factors for 30-day unplanned readmissions after surgical procedures in the elderly population

Urgent hospital readmissions within 30 days of discharge after surgery are a measure of the quality of health and social care. This study aims to identify the characteristics of patients at higher risk of readmission and the main reasons for readmission, stratified by type of surgery.

This cross-sectional study analysed the medical records of patients over 60 years of age in 2022 who had undergone surgery. Records came from hospitals covering an area of 890,000 inhabitants in Northern Italy (ULSS Marca Trevigiana). Risk factors for readmission included demographic characteristics, hospitalisation details, comorbidities, and procedures. Readmission rates and 95% CI were calculated by risk factor, type of intervention and reason for readmission. A logistic model was used to estimate the OR of readmission, adjusting for potential confounders.

The overall 30-day readmission rate was 3.8% (3.5-4.3), with the highest rates after gastrointestinal surgery (49.7 per 1,000 admissions) and the lowest after skin-soft tissue surgeries (15.5 per 1,000 admissions). Multivariate analysis identified dementia (OR = 3.19), end-stage kidney disease or dialysis (OR = 2.84), and metastatic cancer (OR = 2.65) as strong predictors of readmission. Advanced age (75+), male gender, primary cancer, and anemia were also independent predictors. Infection was the main reason for readmission. Other significant causes were hemorrhage, thrombosis/embolism, and intestinal obstruction.

The study highlights the importance of identifying risk factors for readmission to improve transitions of care. Targeted interventions for high-risk populations, particularly those with dementia, renal disease, or cancer, are essential to improve postoperative outcomes and alleviate the burden of unplanned readmissions on healthcare systems.