Role of Post-Acute Care on Hospital Readmission After High-Risk Surgery

Abstract

Background: Payment models, including the Hospital Readmissions Reduction Program and bundled payments, place pressures on hospitals to limit readmissions. Against this backdrop, we sought to investigate the association of post-acute care after major surgery and readmission rates.

Methods: We identified patients undergoing high-risk surgery (abdominal aortic aneurysm repair, coronary bypass grafting, aortic valve replacement, carotid endarterectomy, esophagectomy, pancreatectomy, lung resection, and cystectomy) from 2005 to 2010 using the Healthcare Cost and Utilization Project's State Inpatient Database. The primary outcome was readmission rates after major surgery. Secondary outcome was readmission length of stay.

Results: We identified 135,523 patients of whom 56,720 (42%) received post-acute care. Patients receiving post-acute care had higher readmission rates than those who were discharged home (16% versus 10%, respectively; P < 0.001). The risk-adjusted readmission length of stay was greatest for patients who received care from a skilled nursing facility, followed by those who received home care, and lowest for those who did not receive post-acute care (7.1 versus 5.4 versus 4.8 d, respectively; P < 0.001).

Conclusions: The use of post-acute care was associated with higher readmission rates and higher readmission lengths of stay. Improving the support of patients in post-acute care settings may help reduce readmissions and readmission intensity.

Keywords: Home care; Post–acute care; Readmission; Skilled nursing facility; Surgery.

Figure 1.. Risk adjusted readmission length of stay stratified by post-acute care

Legend. Higher levels of post-acute care led to longer risk adjusted readmission length of stay. Error bars represent the 95% confidence interval. Asterisks indicate significant differences between groups, *p<0.001. GEE modeling with gamma distribution and “log link” was used to calculate the risk adjusted readmission length of stay of each type of post-acute care. The means were then converted from the log scale to length of stay via an inverse log transformation. Models were adjusted for age, gender, comorbidity, socioeconomic status, primary payer, year, surgery type, hospital owns a skilled nursing facility, hospital bed size, number of full-time equivalent registered nurses in the hospital, hospital case management team, hospital social work service, complication during index admission, and index admission length of stay.