Trends in day surgery rates.
Ontology highlight
ABSTRACT:
SUBMITTER: Aylin P
PROVIDER: S-EPMC1246075 | biostudies-literature | 2005 Oct
REPOSITORIES: biostudies-literature
Publications
Trends in day surgery rates.
Aylin Paul P Williams Susan S Jarman Brian B Bottle Alex A
BMJ (Clinical research ed.) 20051001 7520
Similar Datasets
Project description:There are limited data available describing relatively contemporary trends in 30-day rehospitalizations among patients who survive hospitalization after an acute myocardial infarction (AMI) in the community setting. We examined decade-long (2001-2011) trends in, and factors associated with, 30-day rehospitalizations in patients discharged from 3 central Massachusetts hospitals after AMI.Residents of the Worcester, MA, metropolitan area discharged after AMI from 3 central Massachusetts hospitals on a biennial basis between 2001 and 2011 comprised the study population (N=4810). Logistic regression analyses were used to examine the association between selected factors and 30-day rehospitalizations. The average age of this population was 69 years, 42% were women, and 92% were white. During the years under study, 18.5% of patients were rehospitalized within 30 days after hospital discharge. Crude 30-day rehospitalization rates decreased from 20.5% in 2001-2003 to 15.8% in 2009-2011. After adjusting for several patient characteristics, there was a reduced odds of being rehospitalized in 2009-2011 (odds ratio 0.74, 95% CI 0.61-0.91) compared with 2001-2003; this trend was slightly attenuated after further adjustment for hospital treatment practices. Female sex, having previously diagnosed heart failure and chronic kidney disease, and the development of in-hospital cardiogenic shock and heart failure were associated with an increased odds of being rehospitalized.While the likelihood of subsequent short-term rehospitalizations remained frequent, we observed an encouraging decline during the most recent years under study. Several high-risk groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of being readmitted.
| S-EPMC4845213 | biostudies-other
Project description:BackgroundReduction in 30-day readmission rate after chronic obstructive pulmonary disease (COPD)-related hospitalization is a national objective. However, little is known about trends in readmission rates in recent years, particularly in priority populations defined by the Agency for Healthcare Research and Quality (AHRQ)(e.g., the elderly, women, racial/ethnic minorities, low-income and rural populations, and populations with chronic illnesses).MethodsWe conducted a retrospective cohort study using data from the State Inpatient Database of eight geographically-dispersed US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington) from 2006 through 2012. We identified all COPD-related hospitalizations by patients ?40 years old. The primary outcome was any-cause readmission within 30 days of discharge from the index hospitalization for COPD.ResultsFrom 2006 to 2012, a total of 845,465 hospitalizations at risk for 30-day readmissions were identified. Overall, 30-day readmission rate for COPD-related hospitalization decreased modestly from 20.0% in 2006 to 19.2% in 2012, an 0.8% absolute decrease (OR 0.991, 95%CI 0.989-0.995, Ptrend<0.001). This modest decline remained statistically significant after adjusting for patient demographics and comorbidities (adjusted OR 0.981, 95%CI 0.977-0.984, Ptrend<0.001). Similar to the overall population, the readmission rate over the 7-year period remained persistently high in most of AHRQ-defined priority populations.ConclusionsOur observations provide a benchmark for future investigation of the impact of Hospital Readmissions Reduction Program on readmissions after COPD hospitalization. Our findings encourage researchers and policymakers to develop effective strategies aimed at reducing readmissions among patients with COPD in an already-stressed healthcare system.
| S-EPMC5718159 | biostudies-literature
Project description:BackgroundRestrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG).MethodsWe retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: "high" (above) and "low" (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (<8 g/dL) discharge Hb levels on 30-day readmission rates by dividing the patients into 4 anemia cohorts based on discharge Hb levels: "no anemia" (>12 g/dL), "mild anemia" (10-11.9 g/dL), "moderate anemia" (8-9.9 g/dL), and "severe anemia" (<8 g/dL). Risk adjustment accounted for age, sex, Charlson comorbidity index, preoperative comorbidities, revision sternotomy, and patient blood management program implementation.ResultsThe "high" and "low" groups had similar patient characteristics except for Hb levels (mean discharge Hb was 10.4 ± 0.9 vs 8.5 ± 0.6 g/dL, respectively). Notably, no evidence for a difference in 30-day readmission rates was noted between the "high" (76/746; 10.2%) and "low" (97/806; 12.0%) (P = .25) Hb cohorts. The 4 anemia cohorts had differences in age, revision sternotomy incidence, Hb levels, certain patient comorbidities, and time to readmission. On multivariable analysis, the risk-adjusted odds of readmission in the "low" Hb cohort (odds ratio, 1.16; 95% confidence interval, 0.84-1.61; P = .36) was not significant compared to the "high" Hb cohort. Compared to patients with discharge Hb ≥8 g/dL, patients with Hb <8 g/dL had a higher incidence of readmission (22/129; 17.1% vs 151/1423; 10.6%; P = .036). On multivariable analysis, Hb <8 g/dL on discharge was predictive of readmission (odds ratio, 1.77; 95% confidence interval, 1.05-2.88; P = .03). The most common reason for readmission was volume overload, followed by infection and arrhythmias.ConclusionsA discharge Hb level below the institution mean for CABG patients does not provide evidence for an association with an increased 30-day readmission rate. In the small number of patients discharged with Hb <8 g/dL, there is a suggestion of increased risk for readmission and larger more controlled studies are needed to verify or refute this finding.
| S-EPMC6533067 | biostudies-literature
Project description:Reduction of early hospital readmissions is a declared goal in the United States economic and quality improvement agenda. A retrospective study was performed using the Nationwide Readmissions Database from 2010 to 2014. Our primary aim was to study the rate of early readmissions and its predictors in liver transplant recipients (LTRs). Our secondary aims were to determine the trends of LT, reasons for readmission, costs and predictors of calendar year mortality. Multivariable logistic regression and Cox proportional hazards models were utilized. The 30-day readmission rate was 30.6% among a total of 25,054 LTRs. Trends of LT were observed to be increased in patients > 65 years (11.7-17.8%, p < 0.001) and decreased in 40-64 years (78.0-73.5%, p = 0.001) during study period. The majority of 30-day readmissions were due to post transplant complications, with packed red blood cell transfusions being the most common intervention during readmission. Medicaid or Medicare insurance, surgery at low and medium volume centers, infections, hemodialysis, liver biopsy, and length of stay > 10 days were the predictors of 30-day readmission. Moreover, number of early readmission, age > 64 years, non-alcoholic cirrhosis, and length of stay > 10 days were significant predictor of calendar year mortality in LTRs. Approximately one third of patients require early admission after LT. Early readmission not only increases burden on healthcare, but is also associated with calendar year mortality. Strategies should be implemented to reduce readmission in patients with high risk of readmission identified in our study.
| S-EPMC7648628 | biostudies-literature
Project description:Introduction/backgroundGiven the uncommon nature of the multi-ligament injured knee, a better understanding of its outcomes may be achieved by contemporary evaluation of a national administrative database. We aim to identify risk factors for 90-day major complications, 90-day readmissions, and subsequent knee surgery after a multi-ligament knee reconstruction.MethodsThe Humana Claims Database was queried for all patients undergoing a multi-ligament knee reconstruction procedure from 2007 to 2016 using International Classification of Diseases (ICD)-9 procedure codes and Current Procedural Terminology (CPT) codes. Outcomes of interest included Center of Medicaid and Medicare Services (CMS)- reportable 90-day complications, 90-day readmission and subsequent ligament reconstruction or total knee arthroplasty. Predictive factors studied included demographics (ie. age, sex, tobacco use) comorbidity burden and operative factors (ie. surgical setting, diagnosis of knee dislocation, concomitant meniscal repair or meniscectomy).Results588 multi-ligament knee reconstruction procedures were identified. The 90-day readmission rate 8.3%. The rate of subsequent ligament surgery was 7.1%. On multivariate regression analysis, a diagnosis of knee dislocation was associated with a four times greater likelihood of readmission and a two and a half greater likelihood of subsequent ligament surgery. Concomitant meniscectomy was associated with higher likelihood of subsequent total knee arthroplasty (9.1, 1.4-67.0) and outpatient setting of surgery compared to inpatient hospital setting was associated with reduced likelihood of readmission.ConclusionWhile uncommon, the patient population undergoing multi-ligament knee surgery is relatively diverse. Understanding common factors predisposing this population to adverse events following surgery may assist in improved outcomes.
| S-EPMC7025971 | biostudies-literature
Project description:BackgroundTo determine the association of 30-day readmission with weekend discharge and the number of holiday days during a hospital stay (holiday ratio).MethodsThis retrospective cohort study used the clinical research database and cancer registry data of our hospital from January 1, 2011 to December 31, 2017. Patient characteristics, tumor factors, clinical laboratory data, and proxies of continuity of care, such as weekend discharge or holiday ratio (holiday days/total hospitalization days), received statistical analysis. Multivariate logistic regression identified the independent factors for 30-day potentially avoidable readmission rate (PAR).ResultsOf 1433 patients receiving tumor resection, 520 (36.29%) had colon cancer; 440 (30.70%) had head and neck cancer (HNC), and 473 (33.01%) had other cancers (lung, liver, and prostate). The rate of 30-day PAR was 6.3% for those with colon cancer, 8.6% for HNC, and 3.6% for other cancers. The 30-day PAR did not significantly differ by discharge on a weekend versus weekday for those with colon cancer (8.33% vs. 5.90%; p = 0.379), HNC (7.06% vs. 9.01%; p = 0.566), or other cancers (0.00% vs. 4.28%; p = 0.960). Colon cancer patients with holiday ratio >0.3 had a higher readmission rate (9.58% vs. 4.82%, p = 0.041). In multivariate analysis, a holiday ratio >0.3 (adjusted odds ratio 2.16; 95% Confidence Interval, 1.05-4.39) in those with colon cancer was an independent predictor of 30-day PAR.ConclusionsWeekend discharge after major surgery did not affect 30-day readmission rates in cancer patients, but the holiday ratio did affect 30-day PAR for those with colon cancer.
| S-EPMC8817097 | biostudies-literature
Project description:BackgroundSurgical mortality results are increasingly being reported and published in the public domain as indicators of surgical quality. This study examined how mortality outlier status at 90 days after colorectal surgery compares with mortality at 30 days and subsequent intervals in the first year after surgery.MethodsAll adults undergoing elective and emergency colorectal resection between April 2001 and February 2007 in English National Health Service (NHS) Trusts were identified from administrative data. Funnel plots of postoperative case mix-adjusted institutional mortality rate against caseload were created for 30, 90, 180 and 365 days. High- or low-mortality unit status of individual Trusts was defined as breaching upper or lower third standard deviation confidence limits on the funnel plot for 90-day mortality.ResultsA total of 171 688 patients from 153 NHS Trusts were included. Some 14 537 (8·5 per cent) died within 30 days of surgery, 19 466 (11·3 per cent) within 90 days, 23 942 (13·9 per cent) within 180 days and 31 782 (18·5 per cent) within 365 days. Eight institutions were identified as high-mortality units, including all four units with high outlying status at 30 days. Twelve units were low-mortality units, of which six were also low outliers at 30 days. Ninety-day mortality correlated strongly with later mortality results (rs ?=?0·957, P?<?0·001 versus 180-day mortality; rs ?=?0·860, P?<?0·001 versus 365-day mortality).ConclusionExtending mortality reporting to 90 days identifies a greater number of mortality outliers when compared with the 30-day death rate. Ninety-day mortality is proposed as the preferred indicator of perioperative outcome for local analysis and public reporting.
| S-EPMC4065361 | biostudies-literature
Project description:OBJECTIVE: We conducted a study to examine recent trends in population-based utilization rates for liver resection surgery in England, to help identify potentially unmet healthcare need and to help inform future service planning. MATERIALS AND METHODS: Hospital Episodes Statistics data were analysed for the 5-year period 2000-1 to 2004-5 to identify episodes of care relating to liver resection surgery (defined as OPSC IV codes J21 to J24, J31, J38 and J39). RESULTS: In England, the liver excision surgery population access rate was 1.82 and 2.95/100,000 general population in 2000-1 and 2004-5, respectively--a 62% increase during the 5-year study period, or a mean 12% annual increase. About two-thirds of all liver resection surgery (69%) related to metastatic liver disease. Between English regions, utilization rates ranged from 0.5 to 4.5/100,000 general population in 2000-1; and from 0.8 to 4.6/100 000 general population in 2004-5. DISCUSSION: In recent years, a rapid increase in liver resection surgery activity has been observed. Most of the activity was related to metastatic disease. There was substantial regional variation in population utilization rates within the same country. This variation is unlikely to represent regional differences in disease burden and healthcare need.
| S-EPMC2215396 | biostudies-other
Project description:ImportanceAs the incidence of oropharyngeal squamous cell carcinoma (OPSCC) continues to rise in the US, an increasing number of patients are being treated with transoral robotic surgery (TORS). Readmission following surgery can potentially delay initiation of adjuvant treatment and affect survival outcomes.ObjectiveTo identify risk factors for 30-day postoperative readmission in patients undergoing TORS for OPSCC.Design, setting, and participantsThis retrospective, population-based cohort study used data from the Nationwide Readmissions Database from 2010 to 2017. All patients undergoing TORS for OPSCC were identified using International Classification of Diseases codes and included. Exclusion criteria were age younger than 18 years or incomplete information regarding index admission or readmission. The analysis was performed from April to October 2023.ExposureTORS for OPSCC.Main outcomes and measuresUnivariate and multivariate analyses were performed to determine factors associated with 30-day readmission. Covariates included demographics and medical comorbidities, socioeconomic factors, hospital characteristics, and surgical details. Trends in readmission over time, reasons for readmission, and characteristics of the readmission were also examined.ResultsA weighted total of 5544 patients (mean [SD] age, 60.7 [0.25] years; 4475 [80.7%] male) underwent TORS for OPSCC. The overall readmission rate was 17.5% (n = 971), and these rates decreased over the study period (50 of 211 patients [23.7%] in 2010 vs 58 of 633 patients [9.1%] in 2017). Risk factors associated with readmission included male sex (adjusted odds ratio [AOR], 1.54; 95% CI, 1.07-2.20) and a diagnosis of congestive heart failure (AOR, 2.42; 95% CI, 1.28-4.58). Factors associated with decreased rate of readmission included undergoing concurrent selective neck dissection (AOR, 0.30; 95% CI, 0.22-0.41). Among the 971 readmissions, the most common readmission diagnoses were bleeding (151 [15.6%]), electrolyte and digestive problems (44 [4.5%]), pneumonia (44 [4.5%]), and sepsis (26 [2.7%]).Conclusions and relevanceIn this cohort study, readmission rates following TORS for oropharynx cancer decreased over time; however, a subset of patients required readmission most commonly related to bleeding, infection, and electrolyte imbalance. Concurrent neck dissection may be protective against readmission. Elucidation of risk factors for readmission after TORS for OPSCC offers opportunities for evidence-based shared decision-making, quality improvement initiatives, and improved patient counseling.
| S-EPMC10853828 | biostudies-literature
Project description:ImportanceThe association of the Hospital Readmission Reduction Program (HRRP) with reductions in racial disparities in 30-day outcomes for myocardial infarction (MI), is unknown, including whether this varies by HRRP hospital penalty status.ObjectiveTo assess temporal trends in 30-day readmission and mortality rates among black and nonblack patients discharged after hospitalization for acute MI at low-performing and high-performing hospitals, as defined by readmission penalty status after HRRP implementation.Design, setting, and participantsThis observational cohort analysis used data from the multicenter National Cardiovascular Data Registry Chest Pain-MI Registry centers that were subject to the first cycle of HRRP, between January 1, 2008, and November 30, 2016. All patients hospitalized with MI who were included in National Cardiovascular Data Registry Chest Pain-MI Registry were included in the analysis. Data were analyzed from April 2018 to September 2019.ExposuresHospital performance category and race (black compared with nonblack patients). Centers were classified as high performing or low performing based on the excess readmission ratio (predicted to expected 30-day risk adjusted readmission rate) for MI during the first HRRP cycle (in October 2012).Main outcomes and measuresThirty-day all-cause readmission and mortality rates.ResultsAmong 753 hospitals that treated 155 397 patients with acute MI (of whom 11 280 [7.3%] were black), 399 hospitals (53.0%) were high performing. Thirty-day readmission rates declined over time in both black and nonblack patients (annualized 30-day readmission rate: 17.9% vs 20.8%). Black (compared with nonblack) race was associated with higher unadjusted odds of 30-day readmission in both low-performing and high-performing centers (odds ratios: before HRRP: low-performing hospitals, 1.14 [95% CI, 1.03-1.26]; P = .01; high-performing hospitals, 1.17 [95% CI, 1.04-1.32]; P = .01; after HRRP: low-performing hospitals, 1.23 [95% CI, 1.13-1.34]; P < .001; high-performing hospitals, 1.25 [95% CI, 1.12-1.39]; P < .001). However, these racial differences were not significant after adjustment for patient characteristics. The 30-day mortality rates declined significantly over time in nonblack patients, with stable (nonsignificant) temporal trends among black patients. Adjusted associations between race and 30-day mortality showed that 30-day mortality rates were significantly lower among black (compared with nonblack) patients in the low-performing hospitals (odds ratios: pre-HRRP, 0.79 [95% CI, 0.63-0.97]; P = .03; post-HRRP, 0.80 [95% CI, 0.68-0.95]; P = .01) but not in high-performing hospitals. Finally, the association between race and 30-day outcomes did not vary after the HRRP period began in either high-performing or low-performing hospitals.Conclusions and relevanceIn this analysis, 30-day readmission rates among patients with MI declined over time for both black and nonblack patients. Differences in race-specific 30-day readmission rates persisted but appeared to be attributable to patient-level factors. The 30-day mortality rates have declined for nonblack patients and remained stable among black patients. Implementation of the HRRP was not associated with improvement or worsening of racial disparities in readmission and mortality rates.
| S-EPMC6990949 | biostudies-literature