Failure to Rescue in Emergency General Surgery: Impact of Fragmentation of Care

Annals of Surgery
Kamil HannaBellal Joseph

Abstract

Compare emergency general surgery (EGS) patient outcomes following index and non-index hospital readmissions, and explore predictive factors for non-index readmission. Readmission to a different hospital leads to fragmentation of care. The impact of non-index readmsision on patient outcomes following EGS is not well established. The Nationwide Readmissions Database (2017) was queried for adult patients readmitted following an EGS procedure. Patients were stratified and propensity-matched according to readmission destination: index vs. non-index hospital. Outcomes were failure to rescue (FTR), mortality, number of subsequent readmissions, overall hospital LOS, and total costs. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors. A total of 471,570 EGS patients were identified, of which 79,127 (16.8%) were readmitted within 30 days: index hospital (61,472; 77.7%) vs. non-index hospital (17,655; 22.3%). Following 1:1 propensity matching, patients with non-index readmission had higher rates of FTR (5.6% vs. 4.3%; p < 0.001), mortality (2.7% vs. 2.1%; p < 0.001), and overall hospital costs (in $1000; 37 [27-64] vs...Continue Reading

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