Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul;225(1):62-67.
doi: 10.1016/j.jamcollsurg.2017.03.017. Epub 2017 Apr 9.

Adverse Effect of Post-Discharge Care Fragmentation on Outcomes after Readmissions after Liver Transplantation

Anai N Kothari  1 , Veronica M Loy, Sarah A Brownlee, Yoshiki Ezure, Colleen Schaidle-Blackburn, Scott J Cotler, Diego di Sabato, Paul C Kuo, Amy D Lu
Affiliations

Adverse Effect of Post-Discharge Care Fragmentation on Outcomes after Readmissions after Liver Transplantation

Anai N Kothari et al. J Am Coll Surg. 2017 Jul.

Abstract

Background: Post-discharge surgical care fragmentation is defined as readmission to any hospital other than the hospital at which surgery was performed. The objective of this study was to assess the impact of fragmented readmissions within the first year after orthotopic liver transplantation (OLT).

Study design: The Healthcare Cost and Utilization Project State Inpatient Databases for Florida and California from 2006 to 2011 were used to identify OLT patients. Post-discharge fragmentation was defined as any readmission to a non-index hospital, including readmitted patients transferred to the index hospital after 24 hours. Outcomes included adverse events, defined as 30-day mortality and 30-day readmission after a fragmented readmission. All statistical analyses considered a hierarchical data structure and were performed with multilevel, mixed-effects models.

Results: We analyzed 2,996 patients with 7,485 readmission encounters at 299 hospitals; 1,236 (16.5%) readmissions were fragmented. After adjustment for age, sex, readmission reason, index liver transplantation cost, readmission length of stay, number of previous readmissions, and time from transplantation, post-discharge fragmentation increased the odds of both 30-day mortality (odds ratio [OR] = 1.75; 95% CI 1.16 to 2.65) and 30-day readmission (OR = 2.14; 95% CI 1.83 to 2.49). Predictors of adverse events after a fragmented readmission included increased number of previous readmissions (OR = 1.07; 95% CI 1.01 to 1.14) and readmission within 90 days of OLT (OR = 2.19; 95% CI 1.61 to 2.98).

Conclusions: Post-discharge fragmentation significantly increases the risk of both 30-day mortality and subsequent readmission after a readmission in the first year after OLT. More inpatient visits before a readmission and less time elapsed from index surgery increase the odds of an adverse event after discharge from a fragmented readmission. These parameters could guide transfer decisions for patients with post-discharge fragmentation.

PubMed Disclaimer

Comment in

  • Discussion.
    [No authors listed] [No authors listed] J Am Coll Surg. 2017 Jul;225(1):67-68. doi: 10.1016/j.jamcollsurg.2017.04.023. J Am Coll Surg. 2017. PMID: 28648349 No abstract available.

References

REFERENCES

    1. Tsai TC, Orav EJ, Jha AK. Care fragmentation in the postdischarge period: surgical readmissions, distance of travel, and postoperative mortality. JAMA Surg. 2015;150:59-64.
    1. Pak JS, Lascano D, Kabat DH, et al. Patterns of care for readmission after radical cystectomy in New York State and the effect of care fragmentation. Urol Oncol. 2015;33:426.e13-426.e19.
    1. Zheng C, Habermann EB, Shara NM, et al. Fragmentation of care after surgical discharge: non-index readmission after major cancer surgery. J Am Coll Surg. 2016;222:780-789.e2.
    1. Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC. Regionalization of high-risk surgery and implications for patient travel times. JAMA. 2003;290:2703-2708.
    1. Chou S, Deily ME, Li S. Travel distance and health outcomes for scheduled surgery. Med Care. 2014;52:250-257.