Variation in Risk-standardized Rates and Causes of Unplanned Hospital Visits Within 7 Days of Hospital Outpatient Surgery.
| Title: | Variation in Risk-standardized Rates and Causes of Unplanned Hospital Visits Within 7 Days of Hospital Outpatient Surgery. |
|---|---|
| Authors: | Desai MM; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.; Zogg CK; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Ranasinghe I; Adelaide Medical School, University of Adelaide, Adelaide, Australia.; Health Performance and Policy Research Unit, Basil Hetzel Institute for Translational Health Research,Woodville South, Australia.; Parzynski CS; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Lin Z; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Gorbaty M; Mathematica Policy Research, Cambridge, Massachusetts.; Merrill A; Mathematica Policy Research, Cambridge, Massachusetts.; Krumholz HM; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut.; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.; Drye EE; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut. |
| Source: | Annals of surgery [Ann Surg] 2022 Dec 01; Vol. 276 (6), pp. e714-e720. Date of Electronic Publication: 2020 Nov 17. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins |
| MeSH Terms: | Ambulatory Surgical Procedures* ; Medicare*; Aged ; Humans ; United States ; Hospitals ; Hospitalization ; Fee-for-Service Plans ; Emergency Service, Hospital ; Retrospective Studies |
| Abstract: | Objectives: The objectives of this study were to compare risk-standardized hospital visit ratios of the predicted to expected number of unplanned hospital visits within 7 days of same-day surgeries performed at US hospital outpatient departments (HOPDs) and to describe the causes of hospital visits.; Summary of Background Data: More than half of procedures in the US are performed in outpatient settings, yet little is known about facility-level variation in short-term safety outcomes.; Methods: The study cohort included 1,135,441 outpatient surgeries performed at 4058 hospitals between October 1, 2015 and September 30, 2016 among Medicare Fee-for-Service beneficiaries aged ≥65 years. Hospital-level, risk-standardized measure scores of unplanned hospital visits (emergency department visits, observation stays, and unplanned inpatient admissions) within 7 days of hospital outpatient surgery were calculated using hierarchical logistic regression modeling that adjusted for age, clinical comorbidities, and surgical procedural complexity.; Results: Overall, 7.8% of hospital outpatient surgeries were followed by an unplanned hospital visit within 7 days. Many of the leading reasons for unplanned visits were for potentially preventable conditions, such as urinary retention, infection, and pain. We found considerable variation in the risk-standardized ratio score across hospitals. The 203 best-performing HOPDs, at or below the 5th percentile, had at least 22% fewer unplanned hospital visits than expected, whereas the 202 worst-performing HOPDs, at or above the 95th percentile, had at least 29% more post-surgical visits than expected, given their case and surgical procedure mix.; Conclusions: Many patients experience an unplanned hospital visit within 7 days of hospital outpatient surgery, often for potentially preventable reasons. The observed variation in performance across hospitals suggests opportunities for quality improvement.; (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.) |
| Competing Interests: | The authors report no conflicts of interest. |
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| Entry Date(s): | Date Created: 20201120 Date Completed: 20221110 Latest Revision: 20221210 |
| Update Code: | 20260130 |
| DOI: | 10.1097/SLA.0000000000004627 |
| PMID: | 33214469 |
| Database: | MEDLINE |
Journal Article