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Kazaure HS, Roman SA, Sosa JA. Association of Postdischarge Complications With Reoperation and Mortality in General Surgery. Arch Surg. 2012;147(11):1000–1007. doi:10.1001/2013.jamasurg.114
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).
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.
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