The following is the summary of “Failure to Rescue in Emergency General Surgery Impact of Fragmentation of Care” published in the January 2023 issue of Surgery by Hanna, et al.
Evaluate the differences between the outcomes of Emergency General Surgery (EGS) patients who were readmitted to the index hospital and those who were readmitted to a different hospital, and look into the characteristics that predict non-index readmission. The fragmentation of care that occurs once a patient is readmitted to a separate hospital is described in the preceding section. There is insufficient evidence about the effect of non-index readmission on patient outcomes following EGS.
Referring to the National Readmissions Database in 2017, we looked for adult patients who were readmitted following an EGS. Patients were separated into two groups, index and non-index, and then propensity-matched based on where they were readmitted from. The results included failure to rescue (FTR), mortality, readmissions, length of hospital stay, and overall expenses. Adjustments for potential confounding factors at both the patient and hospital levels were made using hierarchical logistic regression for accounting for the clustering effect within hospitals. The findings showed that out of a total of 471,570 patients diagnosed with EGS, 79,127 (16.8%) were readmitted within 30 days, with a greater proportion being readmitted to their index hospital (61,472; 77.7%) than their non-index hospital (17,655; 22.3%). Higher rates of FTR (5.6% vs. 4.3%; P<0.001), death (2.7% vs. 2.1%; P<0.001), and overall hospital expenses [in $1000; 37 (27-64) vs. 28 (21-48; P<0.001] were seen among patients who had a non-index readmission following a 1:1 propensity matching.
The adjusted odds ratio was 1.18 (95% CI, 1.03-1.36), and the P value was statistically significant (P<0.001). The following factors predicted non-index readmission: living in the upper-income quartile of the zip code [1.35 (1.08-1.69); P<0.001], living in a rural county [1.08 (1.01-1.16; P=0.049)], being discharged to a skilled nursing facility [1.28 (1.20-1.36); P<0.001], and leaving against medical advice [2.32 (1.81-2.98); P<0.001]. Most patients readmitted after an EGS are treated at the same facility, while one in five is transferred to another facility. There is an increased risk of FTR with non-index readmission.
