Chronic Conditions, Not Surgical Failure Cause Most Hospital Readmissions

Hospitals have been hit with Medicare payment penalties ranging from 1% to 2% of all Medicare payments for readmissions following surgery associated with the management of myocardial infarction, heart failure, and pneumonia. Hip and knee surgeries are expected to be added to the list in the coming year.

Fred Pollock, M.D. and colleagues studied causes for readmissions of patients with a primary admission diagnosis of hip fracture at a level I trauma center in rural Appalachia. The study findings “provide novel data on patients from rural Appalachia who require hospital readmission after initial repair of a hip fracture. This study also provides insight into risk factors and/or patient-specific conditions that may place members of the rural geriatric community at higher risk for hospital readmission after initial management of hip fracture, ” according to the authors.

The study institution was a large facility that serves approximately one-third of West Virginia as a tertiary care facility and level I trauma center. The patient base was primarily rural and spread over a large geographic area. The authors said their patients are often frail with “diminished physiologic reserves as a result of multiple pre-existing medical problems that complicate recovery and lead to hospital readmission. Pre-existing comorbidities often include cardiovascular and pulmonary disease, diabetes, dementia, and osteoporosis that increase the risk of morbidity and prolong recuperation after surgical intervention.”

They published their results in the January 2015 issue of Orthopedics (Orthopedics. 2015; 38(1):e7–e13).

Readmission Rate – 25% Surgical Failure

Here’s what they found in their retrospective cohort study which included 1486 patients who were 65 years or older and had a surgical procedure performed to treat a femoral neck, intertrochanteric, and/or subtrochanteric hip fracture during an eight-year period:

• A 30-day readmission rate of 9.35% (n=139)
• Patients in the readmission group had a significantly higher rate of pre-existing diabetes and pulmonary disease and a longer initial hospital length of stay
• Readmissions were primarily the result of medical complications, with only one-fourth occurring secondary to orthopedic surgical failure
• Pre-existing pulmonary disease (odds ratio [OR], 1.885; 95% confidence interval [CI], 1.305–2.724), initial hospitalization of 8 days or longer (OR, 1.853; 95% CI, 1.223–2.807), and discharge to a skilled nursing facility (OR, 1.586; 95% CI, 1.043–2.413) were determined to be predictors of readmission.

“Accordingly, ” concluded the study, “patient management should be consistently geared toward optimizing chronic disease states while concomitantly working to minimize the duration of initial hospitalization and decrease readmission rates.”

The researchers are from the Orthopedic Trauma Group-Charleston Area Medical Center (FHP, JPM), Charleston; and CAMC Health Education and Research Institute-Center for Health Services and Outcome Research (AB, DS, AM, JTC), Charleston, West Virginia.