Nav: Home

High rate of patient factors linked to hospital readmissions following general surgery

June 15, 2016

An analysis of risk factors for hospital readmission following general surgery finds that a large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions but by issues related to mental health, substance abuse, or homelessness, according to a study published online by JAMA Surgery.

Previous studies investigating patients at risk for hospital readmissions focus on medical services and have found chronic conditions as contributors. Little is known, however, of the characteristics of patients readmitted from surgical services. Lisa K. McIntyre, M.D., of the University of Washington Medical Center, Seattle, and colleagues conducted a study that included 173 general surgical patients (91 men) who were identified as being unplanned readmissions within 30 days among 2,100 discharges (8 percent) at a Level I trauma center and safety-net hospital. Medical records of the patients were reviewed to characterize index and readmission data.

The researchers found that the most common reason for readmission included 29 patients who were initially admitted with soft tissue infections from injection drug use requiring operative drainage and who were then readmitted with new soft tissue infections at other sites (17 percent of readmitted patients). Twenty-five readmitted patients (14.5 percent) were found to have lack of adequate social support leading to issues surrounding the discharge and follow-up process (e.g., lack of home for postdischarge telephone calls, follow-up appointments not scheduled or not attended, postdischarge care needs underestimated). Together, these 2 groups made up almost a third of the readmissions (n = 54, 31 percent).

Other reasons for readmission included 23 patients with infections not detectable during index admission (13 percent), and 16 with illness related to their injury or condition (9 percent). Sixteen patients were identified as having a likely preventable complication of care (9 percent), and 2 were readmitted owing to deterioration of medical conditions (1 percent).

Female sex, presence of diabetes, sepsis on admission, or intensive care unit stay during index admission, as well as discharge to respite care and payer status (Medicaid/Medicare compared with commercial) were identified as risk factors for readmission.

"Many cases of readmissions may truly be unavoidable in our current paradigms of care because we found socially fragile populations to be at as high risk as those that are medically fragile," the authors write. "Because interventions to reduce the risk of readmission for any group of patients can be costly and labor intensive, identification of the highest risk cohort for readmission can allow more targeted intervention for this population of socially vulnerable patients."
-end-
(JAMA Surgery. Published online June 15, 2016. doi:10.1001/jamasurg.2016.1258. This study is available pre-embargo at the For The Media website.)

Editor's Note: No conflict of interest disclosures were reported.

Note: Also available on the For The Media website is an accompanying commentary, "30-Day Readmission Rate - A Blunt Instrument That Needs Honing," by Alexander C. Schwed, M.D., and Christian de Virgilio, M.D., of Harbor-University of California, Los Angeles Medical Center, Torrance.

Media Advisory: To contact Lisa K. McIntyre, M.D., call Susan Gregg at 206-616-6730 or email sghanson@uw.edu.

The JAMA Network Journals

Related Mental Health Articles:

Food insecurity can affect your mental health
Food insecurity (FI) affects nearly 795 million people worldwide. Although a complex phenomenon encompassing food availability, affordability, utilization, and even the social norms that define acceptable ways to acquire food, FI can affect people's health beyond its impact on nutrition.
Climate change's toll on mental health
When people think about climate change, they probably think first about its effects on the environment, and possibly on their physical health.
Quantifying nature's mental health benefits
The BioScience Talks podcast features discussions of topical issues related to the biological sciences.
Sexism may be harmful to men's mental health
Men who see themselves as playboys or as having power over women are more likely to have psychological problems than men who conform less to traditionally masculine norms, according to research published by the American Psychological Association.
Mental health matters
UCSB researchers study the effectiveness of an innovative program designed to help youth learn about mental health.
Could mental math boost emotional health?
Engaging the brain's dorsolateral prefrontal cortex (DL-PFC) while doing mental math may be connected with better emotional health, according to Duke researchers.
Program will train mental health providers, improve health care in rural Missouri
A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration in the US Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.
Loss of employer-based health insurance in early retirement affects mental, physical health
The loss of private health insurance from an employer can lead to poorer mental and physical health as older adults transition to early retirement, according to a study by Georgia State University.
Ocean views linked to better mental health
Here's another reason to start saving for that beach house: new research suggests that residents with a view of the water are less stressed.
New study shows electronic health records often capture incomplete mental health data
This study compares information available in a typical electronic health record (EHR) with data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder.

Related Mental Health Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Moving Forward
When the life you've built slips out of your grasp, you're often told it's best to move on. But is that true? Instead of forgetting the past, TED speakers describe how we can move forward with it. Guests include writers Nora McInerny and Suleika Jaouad, and human rights advocate Lindy Lou Isonhood.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...