TY - JOUR
T1 - Unplanned readmission after emergency laparotomy
T2 - A post hoc analysis of an EAST multicenter study
AU - EAST Multicenter ESS Study Group
AU - Kongkaewpaisan, Napaporn
AU - El Hechi, Majed W.
AU - Naar, Leon
AU - Kaafarani, Haytham M.A.
AU - Aicher, Brittany O.
AU - Diaz, Jose J.
AU - O'Meara, Lindsay B.
AU - Decker, Cassandra
AU - Rodriquez, Jennifer
AU - Schroeppel, Thomas
AU - Rattan, Rishi
AU - Vasileiou, Georgia
AU - Yeh, Daniel Dante
AU - Simonoski, Ursula J.
AU - Turay, David
AU - Cullinane, Daniel C.
AU - Emmert, Cory B.
AU - McCrum, Marta L.
AU - Wall, Natalie
AU - Badach, Jeremy
AU - Goldenberg-Sandau, Anna
AU - Carmichael, Heather
AU - Velopulos, Catherine
AU - Choron, Rachel
AU - Sakran, Joseph V.
AU - Bekdache, Khaldoun
AU - Black, George
AU - Shoultz, Thomas
AU - Chadnick, Zachary
AU - Sim, Vasiliy
AU - Madbak, Firas
AU - Steadman, Daniel
AU - Camazine, Maraya
AU - Zielinski, Martin D.
AU - Hardman, Claire
AU - Walusimbi, Mbaga
AU - Kim, Mirhee
AU - Rodier, Simon
AU - Papadopoulos, Vasileios N.
AU - Tsoulfas, Georgios
AU - Perez, Javier Martin
N1 - Funding Information:
The authors thank the EAST Multicenter ESS Study Group. Contributors from the Eastern Association for the Surgery of Trauma Multicenter Emergency Surgery and Surgical Study group?Department of Surgery, University of Maryland School of Medicine, Baltimore, MD: Brittany O. Aicher, MD, Jose J. Diaz, Jr, MD, CNS, FACS, FCCM, Lindsay B. O'Meara, CRNP; Department of Surgery, University of Colorado Health Memorial Hospital, Colorado Springs, CO: Cassandra Decker, BA, Jennifer Rodriquez, CRC, Thomas Schroeppel, MD, MS; DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL: Rishi Rattan, MD, FACS, Georgia Vasileiou, MD, Daniel Dante Yeh, MD, MHPE, FACS, FCCM; Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA: Ursula J. Simonoski, BS, David Turay, MD, PhD, FACS; Department of Surgery, Marshfield Clinic, Marshfield, WI: Daniel C. Cullinane, MD. Cory B. Emmert, DO; Department of Surgery, University of Utah, Salt Lake City, UT: Marta L. McCrum, MD, MPH, Natalie Wall, BS; Department of Surgery, Cooper University Hospital, Camden, NJ: Jeremy Badach, MD, Anna Goldenberg-Sandau, DO; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO: Heather Carmichael, MD, Catherine Velopulos, MD, MHS, FACS; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD: Rachel Choron, MD, Joseph V. Sakran, MD, MPH, MPA, FACS; Department of Surgery, Eastern Maine Medical Center, Bangor, ME: Khaldoun Bekdache, MD; Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX: George Black, MD, Thomas Shoultz, MD; Department of Surgery, Staten Island University Hospital, Staten Island, NY: Zachary Chadnick, MD, Vasiliy Sim, MD; Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL: Firas Madbak, MD, FACS, Daniel Steadman, DO; Department of Surgery, Mayo Clinic, Rochester, MN: Maraya Camazine, MS, Martin D. Zielinski, MD, FACS; Department of Surgery, Miami Valley Hospital, Centerville, OH: Claire Hardman, RN, BSN, Mbaga Walusimbi, MD; Department of Surgery, New York University School of Medicine, New York, NY: Mirhee Kim, BA, Simon Rodier, MD, MPhil; Department of Surgery, Papageorgiou General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece: Vasileios N. Papadopoulos, MD, PhD, Georgios Tsoulfas, MD, PhD; Department of Surgery, Hackensack University Medical Center, Hackensack, NJ: Javier Martin Perez, MD.
Publisher Copyright:
© 2020
PY - 2021/6
Y1 - 2021/6
N2 - Background: Hospital readmission is an important quality-of-care indicator. We sought to examine the rates and predictors of unplanned readmission for the high-risk non-trauma emergency laparotomy patient. Methods: This is a post hoc analysis of a multicenter prospective observational study. Between April 2018 and June 2019, a total of 19 centers enrolled all adult patients undergoing emergency laparotomies and systematically collected preoperative, operative, and 30-day postoperative variables. For the purpose of this study, we defined unplanned readmission as a readmission occurring within 30 days from discharge and one that was immediately preceded by an emergency department visit. Patients were excluded if they died during the index admission, were discharged to hospice, or were transferred to other hospitals. Predictors of unplanned readmission were evaluated using a multivariable logistic regression model, adjusting for patient demographics, comorbidities, laboratory variables, and preoperative acuity of disease variables. Results: A total of 1,347 patients were included, of which 234 (17.4%) had an unplanned readmission. The median patient age was 60 y, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%). Predictors of unplanned readmission included patient factors (eg, disseminated cancer [odds ratio: 2.22, confidence interval: 1.35–3.64, P =.002], weight loss >10% in the past 6 months [odds ratio: 1.65, confidence interval: 1.07–2.54, P =.023], dyspnea at baseline [odds ratio: 1.62, confidence interval: 1.06–2.48, P =.026], wound complications [odds ratio: 2.23, confidence interval: 1.55–3.19, P <.001], and discharge to nursing homes [odds ratio: 1.68, confidence interval: 1.02–2.80, P =.044]). Conclusion: Unplanned readmission after emergency laparotomies are common, especially for patients with wound complications or requiring nursing homes. These system factors are potential quality improvement targets to reduce readmissions.
AB - Background: Hospital readmission is an important quality-of-care indicator. We sought to examine the rates and predictors of unplanned readmission for the high-risk non-trauma emergency laparotomy patient. Methods: This is a post hoc analysis of a multicenter prospective observational study. Between April 2018 and June 2019, a total of 19 centers enrolled all adult patients undergoing emergency laparotomies and systematically collected preoperative, operative, and 30-day postoperative variables. For the purpose of this study, we defined unplanned readmission as a readmission occurring within 30 days from discharge and one that was immediately preceded by an emergency department visit. Patients were excluded if they died during the index admission, were discharged to hospice, or were transferred to other hospitals. Predictors of unplanned readmission were evaluated using a multivariable logistic regression model, adjusting for patient demographics, comorbidities, laboratory variables, and preoperative acuity of disease variables. Results: A total of 1,347 patients were included, of which 234 (17.4%) had an unplanned readmission. The median patient age was 60 y, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%). Predictors of unplanned readmission included patient factors (eg, disseminated cancer [odds ratio: 2.22, confidence interval: 1.35–3.64, P =.002], weight loss >10% in the past 6 months [odds ratio: 1.65, confidence interval: 1.07–2.54, P =.023], dyspnea at baseline [odds ratio: 1.62, confidence interval: 1.06–2.48, P =.026], wound complications [odds ratio: 2.23, confidence interval: 1.55–3.19, P <.001], and discharge to nursing homes [odds ratio: 1.68, confidence interval: 1.02–2.80, P =.044]). Conclusion: Unplanned readmission after emergency laparotomies are common, especially for patients with wound complications or requiring nursing homes. These system factors are potential quality improvement targets to reduce readmissions.
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U2 - 10.1016/j.surg.2020.11.047
DO - 10.1016/j.surg.2020.11.047
M3 - Article
C2 - 33431187
AN - SCOPUS:85099158442
SN - 0039-6060
VL - 169
SP - 1434
EP - 1440
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -