Prediction models of Medicare 90-day postdischarge deaths, readmissions, and costs in bowel operations

Abstract

Background: The 90-day postdischarge morbidity and mortality rates following elective and emergent bowel surgery remain poorly defined.

Methods: The 2009 to 2011 Medicare inpatient files for patients undergoing elective and emergent small and large bowel operations in 1,024 hospitals that passed present-on-admission coding accuracy standards had prediction models designed for inpatient mortality, prolonged postoperative length of hospital stay (prLOS), 90-day postdischarge mortality and readmissions, and total hospital costs.

Results: Of 118,758 patients studied, there was a 4.7% inpatient mortality rate and 7.3% prLOS among live discharges. An additional 7,586 deaths and 26,969 readmissions occurred within 90 days of discharge. Prolonged preoperative and prolonged postoperative hospitalizations were significant (P < .0001) variables in predicting postdischarge deaths and readmissions. Total hospital costs were increased by over $18,000 per adverse outcome.

Conclusion: Postdischarge deaths and readmissions are more common than inpatient adverse events of death and prLOS in elective and emergent Medicare large and small bowel operations.

Keywords: Control charts; Large bowel surgery; Postdischarge deaths; Postdischarge readmissions; Risk-adjusted outcomes; Small bowel surgery.