PREDICTORS OF NON-ROUTINE DISCHARGE AND READMISSION AFTER GASTRIC SURGERY
Kyra N. Folkert*, Kent Grosh, Saad Shebrain, gitonga munene
surgery, Western Michigan University, Kalamazoo, MI
Background: Data on predictors of nonroutine discharge and readmission among patients undergoing gastric surgery remain poorly defined. We sought to define factors associated with nonroutine discharge to home with home health care or to a skilled nursing facility or intermediate care facility and determine the predictors of early (<30 days) and late readmission (30-90 days).
Methods: The HCUP (Healthcare Utilization Project) Nationwide Readmissions Database was queried for individuals who underwent gastric surgeries 2012-2014 and were discharged home with home health care or to a skilled nursing facility/intermediate care facility.
Results: A total of 13,108 patients underwent gastric surgery and 6201 (47.3%)patient discharges were considered non-routine. Compared with patients discharged home, patients associated with non-routine discharge were older with median (interquartile range) age: 69.31 years (60.4-77.2) vs. 63.7, (54.4-71.9), p=??, had more comorbidities (p<0.001), had surgery at small or medium size hospitals with odd ratio, OR (95% confidence interval, CI) of 0.56 (0.38-0.82), and 0.76 (0.63-0.92), p<0.001 respectively .They had lower rates of adenocarcinoma with OR 0.70 (0.61-0.80), p<0.001. Non elective operative procedure was also associated with nonroutine discharge with OR 0.7 (0.66-0.92). 29.9 % of patients who undergo gastric surgery were readmitted within 90 days. Early and late readmissions were also associated with non-routine discharge with OR 1.49 (1.27-1.74), and OR 1.47 (1.22-1.77) respectively.
Conclusion: Nearly 30% of patients undergoing gastric surgery were readmitted within 90 days of surgery. Age, severity of comorbidities, length of stay, hospital size, diagnosis of adenocarcinoma, non-elective surgery, and payer source, were associated with nonroutine discharge.
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