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      Predictors of readmission after outpatient plastic surgery.

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          Abstract

          Hospital readmissions have become a topic of focus for quality care measures and cost-reduction efforts. However, no comparative multi-institutional data on plastic surgery outpatient readmission rates currently exist. The authors endeavored to investigate hospital readmission rates and predictors of readmission following outpatient plastic surgery.

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          Most cited references19

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          Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program.

          Mira Shiloach, Stanley Frencher, Janet E Steeger … (2010)
          Data used for evaluating quality of medical care need to be of high reliability to ensure valid quality assessment and benchmarking. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has continually emphasized the collection of highly reliable clinical data through its program infrastructure. We provide a detailed description of the various mechanisms used in ACS NSQIP to assure collection of high quality data, including training of data collectors (surgical clinical reviewers) and ongoing audits of data reliability. For the 2005 through 2008 calendar years, inter-rater reliability was calculated overall and for individual variables using percentages of agreement between the data collector and the auditor. Variables with > 5% disagreement are flagged for educational efforts to improve accurate collection. Cohen's kappa was estimated for selected variables from the 2007 audit year. Inter-rater reliability audits show that overall disagreement rates on variables have fallen from 3.15% in 2005 (the first year of public enrollment in ACS NSQIP) to 1.56% in 2008. In addition, disagreement levels for individual variables have continually improved, with 26 individual variables demonstrating > 5% disagreement in 2005, to only 2 such variables in 2008. Estimated kappa values suggest substantial or almost perfect agreement for most variables. The ACS NSQIP has implemented training and audit procedures for its hospital participants that are highly effective in collecting robust data. Audit results show that data have been reliable since the program's inception and that reliability has improved every year. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
          Article 0 comments Cited 172 times – based on 0 reviews     Review now
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            Unanticipated admission after ambulatory surgery--a prospective study.

            J. Su, J Fortier, J Su (1998)
            To determine the incidence, the reasons, and the predictive factors for unanticipated admission after ambulatory surgery. Preoperative, intraoperative, and postoperative data were collected prospectively on 15,172 consecutive ambulatory surgical patients during a 32-month period. The data were built into a statistical model, and predictive factors were identified and classified. The overall incidence of unanticipated admission was 1.42%. Admitted patients were more likely to be older, male, and ASA status II or III. Duration of anaesthesia was longer, and surgery was more likely to be completed after 3 pm. Length of stay in the Postanaesthesia Care Unit and the Ambulatory Surgery Unit was longer. Surgical reasons were cited in 38.1% of admitted patients; anaesthesia-related reasons were cited in 25%; social reasons accounted for 19.5%, and medical reasons for 17.2%. Ear, nose and throat (ENT) patients had the highest unanticipated admission rate (18.2%), followed by urology (4.8%) and chronic pain block (3.9%). Gynaecological patients had the lowest rate (0.4%). Among the predictive factors found were male, ASA status II and III, long duration of surgery, surgery finishing after 3 pm, postoperative bleeding, excessive pain, nausea and vomiting, and excessive drowsiness or dizziness. Earlier operating time for certain surgical procedures, screening for proper support at home, and implementation of clinical pathways to deal aggressively with problems such as pain, nausea and vomiting should decrease the incidence of unanticipated admission.
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              Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs.

              Kim C Coley, Brian Williams, Stacey V DaPos … (2002)
              To determine the rate of unanticipated admissions and readmissions, and to characterize the associated reasons and costs. Retrospective medical records database analysis. University teaching hospital. Any patient undergoing same day surgery (SDS) during a 12-month period. All nonelective return visits to the hospital within 30 days and the reasons for return were identified. There were a total of 20,817 patients who underwent SDS in 1999; 1,195 (5.7%) of these returned to the hospital within 30 days or were admitted directly after surgery. Of those unanticipated admissions and readmissions, 313 (1.5%) were directly related to the original SDS procedure. The mean age of these patients was 51 years, 164 (52%) were female, and 266 (85%) were Caucasian. Pain was the most commonly reported reason for return, occurring in 120 (38%) patients who had an unanticipated admission or readmission. After controlling for SDS volume, the general surgery service had the highest rate of unanticipated admissions or readmissions (3.2%), followed by otolaryngology (3.1%) and urology (2.9%). Of the 120 patients returning with unanticipated admissions and readmissions due to pain, 46 (38%) had orthopedic procedures during their index SDS. Mean charges for patients with unanticipated admissions and readmission due to pain were $1,869 +/- $4,553 per visit, whereas charges for nonpain related readmissions were $12,000 +/- $36,886. At our teaching institution, approximately 1.5% of patients undergoing outpatient ambulatory surgery return within 30 days due to problems directly related to the original surgical procedure. Pain accounted for more than one third of return visits, incurring significant costs. Efforts to manage pain should focus not only on pain in the hospital but also anticipation of pain-related issues on discharge.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Plast. Reconstr. Surg.
                Title: Plastic and reconstructive surgery
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Electronic): 1529-4242
                ISSN (Print): 0032-1052
                Publication date (Electronic): Jan 2014
                Volume: 133
                Issue: 1
                Affiliations
                [1 ] Nashville and Memphis, Tenn.; and Chicago, Ill. From the Vanderbilt School of Medicine; the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine; and the Department of Plastic and Reconstructive Surgery, University of Tennessee.
                Article
                DOI: 10.1097/01.prs.0000436833.11442.8d
                PubMed ID: 24105090
                SO-VID: 2e5a9476-b890-445b-99e9-93cc31f59d2f
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