State of Surgical Readmissions Within the Military Health System (2020-2023)

To evaluate the current state of healthcare disparities within the Military Health System, comparing Department of Defense facilities to treatment outsourced to the civilian sector.

Racial disparities in healthcare outcomes remain a critical concern in the US, even in the setting of universal insurance provisions. Despite prior studies suggesting reduced disparities within the Military Health System, challenges such as reduced surgical volume, staffing shortages, and the COVID-19 pandemic may have exacerbated inequalities, particularly among racial and ethnic minorities.

We performed a retrospective cohort study of healthcare claims data evaluating 90-day readmission in adult TRICARE beneficiaries undergoing surgical procedures between 2020 and 2023. The outcome of interest was readmission to an inpatient facility within 90-days of the index surgery, irrespective of the original site of service. Multivariable logistic regression and interaction analyses assessed the association of race, surgical care settings, Charlson Comorbidity Index (CCI) score, and patient characteristics with 90-day readmission.

A total of 262,344 surgeries among 244,008 beneficiaries were identified for inclusion. Black patients with CCI of 0 were more likely to experience 90-day readmissions to private sector hospitals (adjusted odds ratio [AOR] = 1.19; 95% confidence interval [CI] = 1.17-1.22) and direct care facilities (AOR = 1.08; 95% CI = 1.05-1.11). Readmission in direct care was appreciated for Hispanic patients with a CCI of 1 (AOR = 1.14; 95% CI = 1.13-1.15).

We found significant increases in 90-day readmissions among Black and Hispanic patients based on CCI score within the direct care setting. We believe this reflects recent challenges that have impacted both staffing and surgical volume within these facilities.