Association of Postdischarge Complications With Reoperation and Mortality in General Surgery | Colorectal Surgery | JAMA Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program.  N Engl J Med. 2009;360(14):1418-142819339721PubMedGoogle ScholarCrossref
Kocher RP, Adashi EY. Hospital readmissions and the Affordable Care Act: paying for coordinated quality care.  JAMA. 2011;306(16):1794-179522028355PubMedGoogle ScholarCrossref
Bilimoria KY, Cohen ME, Ingraham AM,  et al.  Effect of postdischarge morbidity and mortality on comparisons of hospital surgical quality.  Ann Surg. 2010;252(1):183-19020531000PubMedGoogle ScholarCrossref
Yu P, Chang DC, Osen HB, Talamini MA. NSQIP reveals significant incidence of death following discharge.  J Surg Res. 2011;170(2):e217-e22421816434PubMedGoogle ScholarCrossref
Schilling PL, Dimick JB, Birkmeyer JD. Prioritizing quality improvement in general surgery.  J Am Coll Surg. 2008;207(5):698-70418954782PubMedGoogle ScholarCrossref
American College of Surgeons National Surgical Quality Improvement Program.  ACS-NSQIP user guide for the 2010 Participant Data Use File. Accessed March 18, 2012
Raval MV, Hamilton BH, Ingraham AM, Ko CY, Hall BL. The importance of assessing both inpatient and outpatient surgical quality.  Ann Surg. 2011;253(3):611-61821183845PubMedGoogle ScholarCrossref
Merkow RP, Bilimoria KY, McCarter MD,  et al.  Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis.  Ann Surg. 2011;254(1):131-13721527843PubMedGoogle ScholarCrossref
Abarca F, Saclarides TJ, Brand MI. Laparoscopic colectomy: complications causing reoperation or emergency room/hospital readmissions.  Am Surg. 2011;77(1):65-6921396308PubMedGoogle Scholar
Daneman N, Lu H, Redelmeier DA. Discharge after discharge: predicting surgical site infections after patients leave hospital.  J Hosp Infect. 2010;75(3):188-19420435375PubMedGoogle ScholarCrossref
Delgado-Rodríguez M, Gómez-Ortega A, Sillero-Arenas M, Llorca J. Epidemiology of surgical-site infections diagnosed after hospital discharge: a prospective cohort study.  Infect Control Hosp Epidemiol. 2001;22(1):24-3011198018PubMedGoogle ScholarCrossref
Kariv Y, Wang W, Senagore AJ, Hammel JP, Fazio VW, Delaney CP. Multivariable analysis of factors associated with hospital readmission after intestinal surgery.  Am J Surg. 2006;191(3):364-37116490548PubMedGoogle ScholarCrossref
Prospero E, Cavicchi A, Bacelli S, Barbadoro P, Tantucci L, D’Errico MM. Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective.  Infect Control Hosp Epidemiol. 2006;27(12):1313-131717152028PubMedGoogle ScholarCrossref
Martin RCG, Brown R, Puffer LNP,  et al.  Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab.  Ann Surg. 2011;254(4):591-59722039606PubMedGoogle ScholarCrossref
Wick EC, Shore AD, Hirose KM,  et al.  Readmission rates and cost following colorectal surgery.  Dis Colon Rectum. 2011;54(12):1475-147922067174PubMedGoogle ScholarCrossref
Kent TS, Sachs TE, Callery MP, Vollmer CM Jr. Readmission after major pancreatic resection: a necessary evil?  J Am Coll Surg. 2011;213(4):515-52321840738PubMedGoogle ScholarCrossref
Boltz MM, Hollenbeak CS, Julian KG, Ortenzi G, Dillon PW. Hospital costs associated with surgical site infections in general and vascular surgery patients.  Surgery. 2011;150(5):934-94221676424PubMedGoogle ScholarCrossref
Anaya DA, Dellinger EP. Challenges in the prevention of surgical site infections.  Infect Med. 2006;23(3):120-126Google Scholar
Regenbogen SE, Bordeianou L, Hutter MM, Gawande AA. The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection.  Surgery. 2010;148(3):559-56620227100PubMedGoogle ScholarCrossref
Engel H, Huang JJ, Tsao CK,  et al.  Remote real-time monitoring of free flaps via smartphone photography and 3G wireless Internet: a prospective study evidencing diagnostic accuracy.  Microsurgery. 2011;31(8):589-59522072583PubMedGoogle ScholarCrossref
Murphy RXJ Jr, Bain MA, Wasser TE, Wilson E, Okunski WJ. The reliability of digital imaging in the remote assessment of wounds: defining a standard.  Ann Plast Surg. 2006;56(4):431-43616557079PubMedGoogle ScholarCrossref
Shah A, Tuggle C, Clune JE, Steinbacher D, Patel A. FaceTime with Apple and information technology.  Plast Reconstr Surg. 2012;129(3):562e-563e22374017PubMedGoogle Scholar
Tuggle CT, Park LS, Roman S, Udelsman R, Sosa JA. Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly.  Ann Surg Oncol. 2010;17(11):2816-282320552406PubMedGoogle ScholarCrossref
Robles L, Slogoff M, Ladwig-Scott E,  et al.  The addition of a nurse practitioner to an inpatient surgical team results in improved use of resources.  Surgery. 2011;150(4):711-71722000183PubMedGoogle ScholarCrossref
Graham J, Tomcavage JM, Salek D, Sciandra J, Davis DE, Stewart WF. Postdischarge monitoring using interactive voice response system reduces 30-day readmission rates in a case-managed Medicare population.  Med Care. 2012;50(1):50-5721822152PubMedGoogle ScholarCrossref
Shiloach M, Frencher SK Jr, Steeger JE,  et al.  Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program.  J Am Coll Surg. 2010;210(1):6-1620123325PubMedGoogle ScholarCrossref
Original Article
Nov 2012

Association of Postdischarge Complications With Reoperation and Mortality in General Surgery

Author Affiliations

Author Affiliations: Department of General Surgery, Stanford University, Palo Alto, California (Dr Kazaure); and Department of Surgery, Yale University School of Medicine, New Haven, Connecticut (Drs Roman and Sosa).

Arch Surg. 2012;147(11):1000-1007. doi:10.1001/2013.jamasurg.114

Objectives To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures.

Design Retrospective cohort study.

Setting American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files.

Patients A total of 551 510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting.

Main Outcome Measures Postdischarge complications, reoperation, and mortality.

Results Of 551 510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use.

Conclusions The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.