Background:
A recent focus on reducing rehospitalizations is motivated by the mandate to improve medical and surgical hospital care quality, and internists are increasingly involved in improving the care of surgical patients. However, little is known from the patients' perspective about the experience of postdischarge care and the causes of rehospitalization after elective surgery.
Methods:
Perioperative medicine patients who underwent elective surgery at 1 large surgical referral center were recruited into a prospective observational cohort study. An in‐hospital questionnaire solicited information about environmental and socioeconomic readmission risk factors. A 30‐day postdischarge questionnaire primarily assessed details about clinic visits, emergency department (ED) visits, and rehospitalizations. Clinical and administrative data augmented patient‐reported data.
Results:
Of the 400 patients who agreed to participate, 374 completed the 30‐day questionnaire (completion rate, 94%). Half of all unplanned rehospitalizations (experienced by 13% of patients) and nonrehospitalization ED visits (experienced by 6%) occurred within 10 days of discharge. Medical services accepted 33% of surgical readmissions to the discharging hospital. Patients used EDs and were rehospitalized at facilities near their home (mean traveled distance, 12.1 miles). The most common primary reason for rehospitalization was postoperative complications such as infections, according to patient report, clinical records, and administrative data. Poor social support, perceived care coordination, and overall health were associated with higher readmission risk.
Conclusions:
Surgical complications dominated the reasons for rehospitalizations after elective surgery. Strategies to improve care quality around elective surgery at referral centers should target the discharge process and the coordinated management of postoperative complications through care received at regional hospitals.