Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study

Michael H. McGillion, RN, PhD; Flavia K. Borges, MD, PhD; David Conen, MD, MPH; Daniel I. Sessler, MD; Brenda L. Coleman, RN, PhD; Maura Marcucci, MD, MSc; Carley Ouellette, RN, MSc; Marissa Bird, RN, PhD; Carly Whitmore, RN, PhD; Shaunattonie Henry, RN, PhD; Sandra Ofori, MD, MSc; Shirley M. Pettit, RN; Deborah M. Bedini, RN, MHS; Leslie P. Gauthier, MScT; Jennifer Lounsbury, RN(EC), MN; Nancy M. Carter, RN, PhD; Vikas Tandon, MD; Ameen Patel, MD; Teresa Cafaro, MD, MSc; Marko R. Simunovic, MD; John A. Harlock, MD; Diane Heels-Ansdell, MSc; Fadi Elias, MD, MS; Theodore Rapanos, MD; Shawn Forbes, MD; Elizabeth Peter, RN, PhD; Judy Watt-Watson, RN, PhD; Kelly Metcalfe, RN, PhD; Sandra L. Carroll, RN, PhD; Philip J. Devereaux, MD, PhD

doi:10.1097/AS9.0000000000000417

Annals of Surgery Open (Jun 2024)

Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study

Michael H. McGillion, RN, PhD,
Flavia K. Borges, MD, PhD,
David Conen, MD, MPH,
Daniel I. Sessler, MD,
Brenda L. Coleman, RN, PhD,
Maura Marcucci, MD, MSc,
Carley Ouellette, RN, MSc,
Marissa Bird, RN, PhD,
Carly Whitmore, RN, PhD,
Shaunattonie Henry, RN, PhD,
Sandra Ofori, MD, MSc,
Shirley M. Pettit, RN,
Deborah M. Bedini, RN, MHS,
Leslie P. Gauthier, MScT,
Jennifer Lounsbury, RN(EC), MN,
Nancy M. Carter, RN, PhD,
Vikas Tandon, MD,
Ameen Patel, MD,
Teresa Cafaro, MD, MSc,
Marko R. Simunovic, MD,
John A. Harlock, MD,
Diane Heels-Ansdell, MSc,
Fadi Elias, MD, MS,
Theodore Rapanos, MD,
Shawn Forbes, MD,
Elizabeth Peter, RN, PhD,
Judy Watt-Watson, RN, PhD,
Kelly Metcalfe, RN, PhD,
Sandra L. Carroll, RN, PhD,
Philip J. Devereaux, MD, PhD

Affiliations

Michael H. McGillion, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Flavia K. Borges, MD, PhD: † Population Health Research Institute, Hamilton, ON, Canada
David Conen, MD, MPH: † Population Health Research Institute, Hamilton, ON, Canada
Daniel I. Sessler, MD: ‖ Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH
Brenda L. Coleman, RN, PhD: ¶ Sinai Health System, Toronto, ON, Canada
Maura Marcucci, MD, MSc: † Population Health Research Institute, Hamilton, ON, Canada
Carley Ouellette, RN, MSc: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Marissa Bird, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Carly Whitmore, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Shaunattonie Henry, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Sandra Ofori, MD, MSc: † Population Health Research Institute, Hamilton, ON, Canada
Shirley M. Pettit, RN: † Population Health Research Institute, Hamilton, ON, Canada
Deborah M. Bedini, RN, MHS: ** Hamilton Health Sciences, Hamilton General Hospital, Hamilton, ON, Canada
Leslie P. Gauthier, MScT: †† Hamilton Health Sciences, Juravinski Hospital, Hamilton, ON, Canada
Jennifer Lounsbury, RN(EC), MN: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Nancy M. Carter, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Vikas Tandon, MD: ‡ School of Medicine, McMaster University, Hamilton, ON, Canada
Ameen Patel, MD: ‡ School of Medicine, McMaster University, Hamilton, ON, Canada
Teresa Cafaro, MD, MSc: † Population Health Research Institute, Hamilton, ON, Canada
Marko R. Simunovic, MD: †† Hamilton Health Sciences, Juravinski Hospital, Hamilton, ON, Canada
John A. Harlock, MD: ** Hamilton Health Sciences, Hamilton General Hospital, Hamilton, ON, Canada
Diane Heels-Ansdell, MSc: § Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Fadi Elias, MD, MS: ‡‡ Department of Surgery, McMaster University, Hamilton, ON, Canada
Theodore Rapanos, MD: ‡‡ Department of Surgery, McMaster University, Hamilton, ON, Canada
Shawn Forbes, MD: †† Hamilton Health Sciences, Juravinski Hospital, Hamilton, ON, Canada
Elizabeth Peter, RN, PhD: §§ Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Judy Watt-Watson, RN, PhD: §§ Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Kelly Metcalfe, RN, PhD: §§ Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
Sandra L. Carroll, RN, PhD: * From the School of Nursing, McMaster University, Hamilton, ON, Canada
Philip J. Devereaux, MD, PhD: † Population Health Research Institute, Hamilton, ON, Canada

DOI: https://doi.org/10.1097/AS9.0000000000000417
Journal volume & issue: Vol. 5, no. 2
p. e417

Abstract

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Objective:. To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery. Background:. Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability. Methods:. We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109). Results:. Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2–7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30–1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24–1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61–2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24–3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33–1.95) were associated with readmission. Conclusions:. Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.

Published in Annals of Surgery Open

ISSN: 2691-3593 (Online)
Publisher: Wolters Kluwer Health
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://journals.lww.com/aosopen/pages/default.aspx

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