Surgical complications are more likely to land a person back in the hospital than the condition that sent them there in the first place, according to a new report from the American College of Surgeons.
The report analyzed the medical records of nearly 500,000 patients who underwent surgery at 346 hospitals nationwide to determine why patients need to be readmitted within 30 days of discharge. Surprisingly, surgical site infections caused more complications that the original injury.
“It’s a simple observation, but it has very profound implications,” says Karl Bilimoria, MD, assistant professor in surgery-surgical oncology at Northwestern University in Chicago and co-author of the report. “The world thinks that readmissions of patients are related to problems with transitions of care and how you manage the [medical] conditions, but for patients undergoing surgery, it’s not that at all.”
The Top 10 Readmission Reasons
The six surgeries the study examined were bariatric colectomy or proctectomy, hysterectomy, total hip or knee arthroplasty, ventral hernia repair, and lower extremity vascular bypass procedures. The top 10 reasons why patients are readmitted to the hospital after one of these operations are:
1. Surgical Site Infections
2. Bowel/Intestinal Obstruction
3. Bleeding
4. Pulmonary Problems
5. Venus Thromboembolism
6. Dehydration/Nutritional Problems
7. Sepsis
8. Central Nervous System Problems/Cerebrovascular Accident
9. Pain
10. Other Surgical Problems
Bilimoria said hospitals have been attempting to reduce readmission rates for years, and although some progress has been made, infections aren’t completely preventable.
“As surgeons, we’ve been trying hard for centuries, and [there are] a lot of great efforts ongoing to reduce these complications, and we’ve made a small dent,” Bilimoria said. “But wound infections still happen, and it’s just not something we have a magic bullet for, that we can stop and drive to zero,” even if a physicians follow all best practices.
Bilimoria noted that understanding why patients need to be readmitted is the first step in reducing readmission rates.
“If we’re going to act on readmissions to reduce them, it’s important to know why they’re happening, and important from a policy standpoint to know that it might not be so easy to reduce readmissions for these patients. And therefore, our policy regarding readmission reductions may not be very effective.”
Dr. Silverman comments
We work hard to decrease the rate of surgical site infections. We do this through a three-pronged approach:
- Maximizing patient nutritional levels prior to surgery.
- Following infection prevention recommendations during surgery and IV dosing.
- Ensuring the patient practices early range of motion exercises to reduce swelling and decrease wound tension.