Risk factors for 30-day hospital readmission among general surgery patients
Open accessAbstract
BACKGROUND: Hospital readmission within 30 days of an index hospitalization is receiving increased scrutiny as a marker of poor-quality patient care. This study identifies factors associated with 30-day readmission after general surgery procedures. STUDY DESIGN: Using standard National Surgical Quality Improvement Project protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient general surgery procedures at a single academic center between 2009 and 2011. Data were merged with our institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted. Univariate and multivariate analysis was used to identify risk factors associated with 30-day readmission. RESULTS: One thousand four hundred and forty-two general surgery patients were reviewed. One hundred and sixty-three (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal problem/complication (27.6%), surgical infection (22.1%), and failure to thrive/malnutrition (10.4%). Comorbidities associated with risk of readmission included disseminated cancer, dyspnea, and preoperative open wound (p < 0.05 for all variables). Surgical procedures associated with higher rates of readmission included pancreatectomy, colectomy, and liver resection. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (odds ratio = 4.20; 95% CI, 2.89-6.13). CONCLUSIONS: Risk factors for readmission after general surgery procedures are multifactorial, however, postoperative complications appear to drive readmissions in surgical patients. Taking appropriate steps to minimize postoperative complications will decrease postoperative readmissions.
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Disseminated cancer, a pre-operative open wound, and dyspnea are examples of comorbidities tied to early readmission in prior studies.
“Examples of existing comorbidities associated with early readmission include disseminated cancer, pre-operative open wound, and dyspnea.”
From Clinical predictors and outcome implications of early readmission in lung transplant recipients (2017) · cites this paper as [7]
Prior work has linked certain pre-existing conditions to higher 30-day readmission rates after surgery.
“This finding is inconsistent with other studies, in which authors have observed significant relationships between specific pre-existing conditions and increased rates of 30-day readmission in surgical patients.7,12”
From Clinical predictors and outcome implications of early readmission in lung transplant recipients (2017) · cites this paper as [7]
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- Authors
- Kassin, M. T., Owen, R. M., Perez, S. D., Leeds, I., Cox, J. C., Schnier, K., Sadiraj, V., & Sweeney, J. F.
- Affiliations
- Emory University (US)
- Georgia State University (US)
- Corresponding author
- Sweeney, John F.
- Venue
- Journal of the American College of Surgeons
- Published
- 2012-09
- Volume
- 215
- Issue
- 3
- Pages
- 322-330
- ISSN
- 1072-7515 (ISSN-L)
- PMC
- PMC3423490
- OpenAlex
- W2049737437
- Cited by
- 622
- References
- 24
- Citations by year
- 2026: 9 · 2025: 21 · 2024: 27 · 2023: 34 · 2022: 35 · 2021: 34 · 2020: 51 · 2019: 57 · 2018: 50 · 2017: 56 · 2016: 56 · 2015: 72 · 2014: 71 · 2013: 42 · 2012: 3
- FWCI
- 38.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (RC4AG039071)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- 30-day readmission, general surgery, postoperative complications, risk factors, surgical site infection, gastrointestinal complications, postoperative pulmonary complications, comorbidities, pancreatic resection, colectomy, hepatectomy, blood transfusion, malnutrition, surgical quality
- MeSH terms
- Adult, Aged, Georgia, Hospitals, University, Humans, Male, Middle Aged, Patient Readmission, Postoperative Complications, Retrospective Studies, Risk Factors, Surgical Procedures, Operative, Multivariate Analysis, Logistic Models, Outcome Assessment, Health Care
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