Understanding recurrent readmission after major surgery among patients with employer-provided health insurance

Background: Most studies on readmission only report data on first readmission within 30 days. These data may underestimate the true impact of readmission, as recurrent readmissions are common among patients undergoing major surgery. We therefore sought to define characteristics and readmission patterns of patients recurrently readmitted after major surgery. Methods: A total of 81,769 patients discharged after 10 major surgical procedures (coronary artery bypass graft, abdominal aortic aneurysm, carotid endarterectomy, aortic valve replacement, esophagectomy, gastrectomy, pancreatectomy, pulmonary resection, hepatectomy, and colorectal resection) between 2010 and 2012 were identified from a large employer-provided health plan. Maximum number of unplanned readmissions experienced within 365 days of discharge was measured. Results: Median patient age was 55 years, and a slight majority (55.4%) was male. Comorbidities were common as 36.9% had a Charlson comorbidity index (CCI) of ≥2. Median length of stay was 5 (interquartile range, 3 and 8) days. Among 24,344 (29.8%) patients who experienced readmission, 64.0% experienced 1 readmission, whereas 36.0% experienced recurrent readmissions within 365 day of a prior discharge. Compared with patients experiencing 1 readmission, patients with ≥2 readmissions were more likely to be female (47.3% vs 44.2%) and have more comorbidities (Charlson comorbidity index ≥2, 49.5% vs 42.5%; both P <.001). Complications during the index hospitalization were more common among patients experiencing recurrent readmissions (35.5% vs 30.7%, P <.001). Although median length of stay during index hospitalization was longer among patients with recurrent readmissions (6 vs 7 days), median time to first readmission was shorter (97 vs 40 days, both P <.001). Among study cohort, 4.5% experienced 3 or more readmissions; these patients accounted for 14.8% of all admissions and 13.7% of hospital charges for the study cohort during the entire follow-up period. Conclusions: Among patients who underwent major surgery, 3 in 10 patients experienced readmission of which 1 in 10 patients experienced recurrent readmission within 1 year after surgery. Overall 4.5% of patients with ≥3 readmissions accounted for 14.8% of total admission during the study period. Assessment of only first rehospitalization may not fully capture the long-term outcomes after major surgery.