Variation in surgical-readmission rates and quality of hospital care

N Engl J Med. 2013 Sep 19;369(12):1134-42. doi: 10.1056/NEJMsa1303118.


Background: Reducing hospital-readmission rates is a clinical and policy priority, but little is known about variation in rates of readmission after major surgery and whether these rates at a given hospital are related to other markers of the quality of surgical care.

Methods: Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary-artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. We used bivariate and multivariate techniques to assess the relationships between readmission rates and other measures of surgical quality, including adherence to surgical process measures, procedure volume, and mortality.

Results: For the six index procedures, there were 479,471 discharges from 3004 hospitals. The median risk-adjusted composite readmission rate at 30 days was 13.1% (interquartile range, 9.9 to 17.1). In a multivariate model adjusting for hospital characteristics, we found that hospitals in the highest quartile for surgical volume had a significantly lower composite readmission rate than hospitals in the lowest quartile (12.7% vs. 16.8%, P<0.001), and hospitals with the lowest surgical mortality rates had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3% vs. 14.2%, P<0.001). High adherence to reported surgical process measures was only marginally associated with reduced readmission rates (highest quartile vs. lowest quartile, 13.1% vs. 13.6%; P=0.02). Patterns were similar when each of the six major surgical procedures was examined individually.

Conclusions: Nearly one in seven patients hospitalized for a major surgical procedure is readmitted to the hospital within 30 days after discharge. Hospitals with high surgical volume and low surgical mortality have lower rates of surgical readmission than other hospitals.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hospitalization
  • Hospitals / standards
  • Hospitals / statistics & numerical data*
  • Humans
  • Male
  • Medicare
  • Multivariate Analysis
  • Patient Discharge
  • Patient Readmission / statistics & numerical data*
  • Quality of Health Care*
  • Risk Adjustment
  • Surgical Procedures, Operative / mortality
  • Surgical Procedures, Operative / standards*
  • Surgical Procedures, Operative / statistics & numerical data
  • United States