Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study

Napaporn Kongkaewpaisan; Majed W El Hechi; Leon Naar; Haytham M A Kaafarani; Brittany O Aicher; Jose J Diaz, Jr; Lindsay B O'Meara; Cassandra Decker; Jennifer Rodriquez; Thomas Schroeppel; Rishi Rattan; Georgia Vasileiou; Daniel Dante Yeh; Ursula J Simonoski; David Turay; Daniel C Cullinane; Cory B Emmert; Marta L McCrum; Natalie Wall; Jeremy Badach; Anna Goldenberg-Sandau; Heather Carmichael; Catherine Velopulos; Rachel Choron; Joseph V Sakran; Khaldoun Bekdache; George Black; Thomas Shoultz; Zachary Chadnick; Vasiliy Sim; Firas Madbak; Daniel Steadman; Maraya Camazine; Martin D Zielinski; Claire Hardman; Mbaga Walusimbi; Mirhee Kim; Simon Rodier; Vasileios N Papadopoulos; Georgios Tsoulfas; Javier Martin Perez; EAST Multicenter ESS Study Group

doi:10.1016/j.surg.2020.11.047

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Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study

Journal article

Peer reviewed

Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study

Napaporn Kongkaewpaisan, Majed W El Hechi, Leon Naar, Haytham M A Kaafarani, Brittany O Aicher, Jose J Diaz, Jr, Lindsay B O'Meara, Cassandra Decker, Jennifer Rodriquez, Thomas Schroeppel, …

Surgery, Vol.169(6), pp.1434-1440

2021-01-08

DOI: https://doi.org/10.1016/j.surg.2020.11.047

PMID: 33431187

Abstract

Hospital readmission is an important quality-of-care indicator. We sought to examine the rates and predictors of unplanned readmission for the high-risk non-trauma emergency laparotomy patient. This is a post hoc analysis of a multicenter prospective observational study. Between April 2018 and June 2019, a total of 19 centers enrolled all adult patients undergoing emergency laparotomies and systematically collected preoperative, operative, and 30-day postoperative variables. For the purpose of this study, we defined unplanned readmission as a readmission occurring within 30 days from discharge and one that was immediately preceded by an emergency department visit. Patients were excluded if they died during the index admission, were discharged to hospice, or were transferred to other hospitals. Predictors of unplanned readmission were evaluated using a multivariable logistic regression model, adjusting for patient demographics, comorbidities, laboratory variables, and preoperative acuity of disease variables. A total of 1,347 patients were included, of which 234 (17.4%) had an unplanned readmission. The median patient age was 60 y, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%). Predictors of unplanned readmission included patient factors (eg, disseminated cancer [odds ratio: 2.22, confidence interval: 1.35-3.64, P = .002], weight loss >10% in the past 6 months [odds ratio: 1.65, confidence interval: 1.07-2.54, P = .023], dyspnea at baseline [odds ratio: 1.62, confidence interval: 1.06-2.48, P = .026], wound complications [odds ratio: 2.23, confidence interval: 1.55-3.19, P < .001], and discharge to nursing homes [odds ratio: 1.68, confidence interval: 1.02-2.80, P = .044]). Unplanned readmission after emergency laparotomies are common, especially for patients with wound complications or requiring nursing homes. These system factors are potential quality improvement targets to reduce readmissions.

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Title: Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study
Creators: Napaporn Kongkaewpaisan - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Majed W El Hechi - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Leon Naar - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Haytham M A Kaafarani - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: hkaafarani@mgh.harvard.edu
Brittany O Aicher - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Jose J Diaz, Jr - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Lindsay B O'Meara - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Cassandra Decker - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Jennifer Rodriquez - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Thomas Schroeppel - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Rishi Rattan - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Georgia Vasileiou - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Daniel Dante Yeh - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Ursula J Simonoski - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
David Turay - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Daniel C Cullinane - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Cory B Emmert - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Marta L McCrum - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Natalie Wall - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Jeremy Badach - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Anna Goldenberg-Sandau - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Heather Carmichael - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Catherine Velopulos - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Rachel Choron - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Joseph V Sakran - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Khaldoun Bekdache - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
George Black - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Thomas Shoultz - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Zachary Chadnick - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Vasiliy Sim - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Firas Madbak - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Daniel Steadman - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Maraya Camazine - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Martin D Zielinski - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Claire Hardman - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Mbaga Walusimbi - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Mirhee Kim - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Simon Rodier - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Vasileios N Papadopoulos - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Georgios Tsoulfas - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
Javier Martin Perez - Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA
EAST Multicenter ESS Study Group
Publication Details: Surgery, Vol.169(6), pp.1434-1440
Academic Unit: Miller School of Medicine; UMMG Department of Surgery; UMMG Dept of Surgery - Div of Trauma & Surgical Critical Care Services
Language: English
Resource Type: Journal article
PMID: 33431187
Record Identifier: 991031598488402976