The impact of major intraoperative adverse events on hospital readmissions

Anirudh R Nandan; Jordan D Bohnen; David C Chang; D Dante Yeh; Jarone Lee; George C Velmahos; Haytham M A Kaafarani

doi:10.1016/j.amjsurg.2016.03.018

The impact of major intraoperative adverse events on hospital readmissions

Am J Surg. 2017 Jan;213(1):10-17. doi: 10.1016/j.amjsurg.2016.03.018. Epub 2016 Jun 14.

Authors

Anirudh R Nandan¹, Jordan D Bohnen¹, David C Chang², D Dante Yeh¹, Jarone Lee¹, George C Velmahos¹, Haytham M A Kaafarani³

Affiliations

¹ Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St., Suite 810, Boston, MA 02114, USA.
² Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St., Suite 810, Boston, MA 02114, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA.
³ Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St., Suite 810, Boston, MA 02114, USA. Electronic address: hkaafarani@mgh.harvard.edu.

PMID: 27435433
DOI: 10.1016/j.amjsurg.2016.03.018

Abstract

Background: Hospital-wide readmission rates recently became a recognized benchmarking quality metric. We sought to study the independent impact of major intraoperative adverse events (iAEs) on 30-day readmission in abdominal surgery.

Methods: The 2007 to 2012 institutional American College of Surgeons National Surgical Quality Improvement Program and administrative databases for abdominal operations were matched then screened for iAEs using the International Classification of Diseases, 9th Revision, Clinical Modification-based Patient Safety Indicator "Accidental Puncture/Laceration". Flagged charts were reviewed to confirm the presence of iAEs. Major iAEs were defined as class 3 or above, as per our recently validated iAE Classification System. The inpatient database was queried for readmission within 30 days from discharge. Univariate and multivariable models were constructed to analyze the independent impact of major iAEs on readmission, controlling for demographics, comorbidities, American Society of Anesthesiology class, and procedure type/approach/complexity (using relative value units as proxy). Reasons for readmission were investigated using the Agency for Healthcare Research and Quality's International Classification of Diseases, 9th Revision, Clinical Modification-based Clinical Classification Software.

Results: Of 9,274 surgical procedures; 921 resulted in readmission (9.9%), 183 had confirmed iAEs, 73 of which were major iAEs. Procedures with major iAEs had a higher readmission rate compared with procedures with no iAEs [24.7% vs 9.8%, P < .001]. In multivariable analyses, major iAEs were independently associated with a 2-fold increase in readmission rates [OR = 2.17 (95% CI = 1.22 to 3.86); P = .008]; 67% of readmissions after major iAEs were caused by "complications of surgical procedures or medical care" as defined by Agency for Healthcare Research and Quality.

Conclusions: Major iAEs are independently associated with increased rates of 30-day readmission. Preventing iAEs or mitigating their effects can serve as a quality improvement target to decrease surgical readmissions.

Keywords: AHRQ; Intraoperative adverse events; Major intraoperative adverse events; Patient safety; Readmissions; iAEs.

MeSH terms

Adult
Aged
Databases, Factual
Female
Humans
Intraoperative Complications*
Male
Middle Aged
Patient Readmission*
Quality Improvement*
Retrospective Studies
Time Factors
United States