Studying the Differences in Medical and Surgical Readmissions

Readmissions are a concern and a dilemma for hospitals across the nation as the federal government docks facilities when patients are readmitted within 30 days of discharge. It has caused a surge in research about the causes of readmission and strategies to avoid them.

Researchers from the New York University Hospital for Joint Diseases, concerned because few studies have identified differences between types of admissions, conducted a study specifically looking at this topic.

Based on their belief that readmission following orthopedic surgeries are strikingly different than those associated with medical admissions, they structured their investigation to look at these differences. Published in the Bulletin of the Hospital for Joint Diseases, their single institution work shows that strategies developed to reduce medical readmissions may not be as effective in reducing readmissions after elective orthopedic surgery.

They examined all unplanned 30-day readmissions from 2010 through 2012 following an index hospitalization for an elective orthopedic procedure (primary and revision total joint arthroplasty and spine procedure). They also looked at publicly reported medical conditions that comprise 11% of readmissions (acute myocardial infarction, heart failure and pneumonia).

A total of 3,984 medical patients experienced unplanned 30-day readmissions. Following an index admission of heart failure or acute myocardial infarction, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). When pneumonia was the primary diagnosis, the primary reason for readmission was a disease of the respiratory system (34.5%).

Medical patients tended to be readmitted for reasons related to the index diagnosis.

A total of 618 surgical orthopedic patients experienced unplanned 30-day readmissions. Of these, 233 orthopedic patients were readmitted for surgical complications, with wound infection (56%) or wound complication (11.6%) the most common cause.

The origin of almost every complication could be traced back to the time of surgery. Almost 8 of 10 orthopedic readmissions were almost entirely related to events that took place as a direct result of an elective procedure, rather than primarily from a preoperative or aftercare gap.

The researchers note that strategies directed at limiting complications during surgery may be a more efficient use of resources in surgical patients than those directed at patient education. Interventions designed to readmissions following medical admissions should focus on medical diagnoses.