Readmission after major surgery: effect of the postdischarge environment

J Surg Res. 2016 Oct;205(2):318-326. doi: 10.1016/j.jss.2016.06.080. Epub 2016 Jul 5.


Background: Although uncoordinated postdischarge care has been associated with poor clinical outcomes, the effect of discharge to a low healthcare resource area (LHRA) on readmission remains undetermined. We sought to assess how the quality of discharge area health resources impact readmission following major surgery.

Methods: This cross-sectional study was performed by linking Maryland state data for 2012-2015 to the Agency for Healthcare Research and Quality Area Health-Resource File. Patients undergoing one of 11 common surgical procedures were identified. Multivariable logistic regression was performed to assess the effect of discharge area health resource quality on readmission.

Results: A total of 76,747 patients were identified of which 9.4% were discharged to a high healthcare resource area (HHRA), whereas 81.9% of patients were discharged to an LHRA. Perioperative morbidity and length of stay were comparable between HHRA versus LHRA patients (both P > 0.05). Among all patients, 30-d and 90-d readmission was 6.5% and 12.4%, respectively. On multivariable analysis, discharge to LHRA was independently associated with a 19% (odds ratio = 1.19; 95% CI, 1.01-1.41; P = 0.043) and 18% (odds ratio = 1.18; 95% CI, 1.04-1.33; P = 0.010) greater odds of 30-d and 90-day readmission, respectively.

Conclusions: Patients discharged to an area characterized by LHRA were more likely to be readmitted at 30 d and 90 d following index discharge.

Keywords: Postdischarge care; Readmission; Surgical complications.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Female
  • Health Resources / standards*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Maryland
  • Middle Aged
  • Patient Discharge
  • Patient Readmission / statistics & numerical data*
  • Quality Assurance, Health Care
  • Quality Indicators, Health Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Surgical Procedures, Operative*