The People's Perspective on Medicine

Why Do Surgical Patients Land Back in the Hospital?

Most surgical readmissions appear to be due to post-operative complications that show up once the patient has gone home.
Hospital entrance

Hospitals have begun paying much more attention to readmissions of patients within a month after they have been discharged.

That is because neither Medicare nor Medicaid will pay for the care of such patients. The rationale is that hospitals will need to help patients stay well after they get home.

To learn how to do that, though, hospital administrators need to know why patients are being readmitted. A new study in JAMA examined unplanned surgical readmissions.

Causes for Readmission

Infection of the surgical site was the most common reason for patients to land back in the hospital, accounting for about 20% of readmissions overall. That adds up to more than 5500 patients readmitted during the course of 2012 from the 300 plus hospitals in the study.

Bariatric surgery had a high rate of digestive tract dysfunction (ileus) or obstruction, about 25%. Another complication that brought discharged surgical patients back to the hospital was bleeding. The authors concluded that readmissions after surgery were mostly due to new post-discharge complications, rather than problems that had appeared before patients were sent home.

Can Hospitals Get to Zero?

In an accompanying editorial, Dr. Lucien Leape urges health care systems to learn from the best hospitals and surgeons who have the lowest rates of post-operative complications, and work in collaboration rather than competition. With great effort, he believes, it is possible to “get to zero” patient harm.

[JAMA, Feb. 3, 2015]

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    A trip to the emergency room after a fall (following surgery) found that I had suffered a compound fracture of the L1 vertebrae. The attending physician told the ER nurse that I could return home. I told the nurse that I was not able to return home due to the pain, and the physician (from another room) told the nurse to have me admitted to the hospital. At no time did the doctor face or speak to me personally. A hospitalist then determined after a stay of only l 1/2 days that I should be sent to a nursing facility. Of course this meant no financial help since I was not in the hospital for the designated number of days. I had no family or advocate with me when the hospital social worker visited me and a decision had to be made that day as to where I would go. My fall, in part, was due I think to the prescription I had been given by the surgeon (percoset) which affected my balance, etc. when getting up in the night. After the surgery, neither the surgeon or his nurse had asked whether I was alone or would be having someone with me when I went home….and as the case would be, I was alone following surgery. Doctors have forgotten, if they ever knew, how to deal effectively with patients.

    In today’s world, I would not be afraid to speak up and inform a doctor or nurse that I would be alone at home, wouldn’t be covered with such a short stay, and so on.

    It is our health and our lives at risk here, folks. Make the noises!

    As both a retired RN and a hospital patient, I know that folks are discharged too soon. Yes, I do know all about the insurance rules for length of stay, but throwing patients out the door, whether or not they’re ready, is outrageous. So many people have no decent back up system nor even the physical facilities necessary for recovery. Doctors don’t know either, that’s not their job. Some entity needs to educate and assist discharge BEFORE the surgery whenever possible so patients can have everything ready when they get home. Saves money and misery for all concerned parties.

    From my own experience: it is vital to learn all you can about possible complications before your surgery. Even when you get information from the doctor it may be incomplete. When I had my thyroid removed due to cancer, I was told if I felt tingling around my mouth to take Tums, my calcium might drop. The surgery was what they call a 23 hour surgery, I stayed overnight, was sent home one hour before my check in time the day before. Tho I had no symptoms, my records showed my calcium levels were somewhat below the lowest number on the range. And a lot lower than when I came in. Something should have been done then. I went home Saturday, I was at the ER Sunday with tetany so bad I could not open my eyes nor my mouth. Needed help walking. The ER doctor explained it all to me. Two weeks less a day I was back, not as bad because I had been taking calcium and magnesium. The ER doctor said I probably would be back another 5! times. I said there must be a better way, saw my pcp the next day and he told me I could take a vitamin D at hormone levels to hold onto my calcium. 13 years now, still taking it. How about a little education before the surgery and some medication on hand? Bandages if there is extra bleeding and information on how to use them. Or a nurse coming in for several days right after going home? Well, I could go on and on; it is obvious medicine as practiced today is outmoded and sometimes dangerous.

    I have taken care of friends after surgery twice in the last 5 years and gotten no
    information on how to do this. One friend had broken both bones in her lower leg and the other had breast surgery. I think this is one of the main problems in the fee-for-service model of medicine. Once they have the money they are not interested in helping with after-care. I was absolutely appalled at the lack of information. I am a member of Group Health in Washington State and they have thought of every possible way to help patients with all aspects of treatments and after care. This is a very important part of health care delivery and something that I think the ACA will improve.

    * Be nice, and don't over share. View comment policy^