Digestive Diseases and Sciences

, Volume 60, Issue 1, pp 47–53 | Cite as

Factors Related to Readmission After Major Elective Surgery

  • Gregory C. Wilson
  • R. Cutler QuillinIII
  • Jeffrey M. Sutton
  • Koffi Wima
  • Joshua J. Shaw
  • Richard S. Hoehn
  • Ian M. Paquette
  • Daniel E. Abbott
  • Shimul A. Shah
Original Article



Hospital readmissions have received increased scrutiny as a marker for excessive resource utilization and also quality care.


To identify the rate of and risk factors for hospital readmission after major surgery at academic medical centers.


Using the University Health Consortium Clinical Database, 30-day readmission rates in all adult patients undergoing colectomy (n = 103,129), lung resection (n = 73,558), gastric bypass (n = 62,010) or abdominal aortic surgery (n = 17,997) from 2009 to 2012 were identified. Logistic regression was performed to examine risks for readmission.


Overall readmission rates ranged from 8.9 % after gastric bypass to 15.8 % after colectomy. Black race was associated with increased likelihood for readmission after three of the four procedures with odds ratios ranging from 1.13 after colectomy to 1.44 after gastric bypass. For all procedures, moderate, severe, or extreme severity of illness (SOI) and need for transitional care were associated with increased odds for hospital readmission. Lower center volume was an independent predictor of readmission after gastric bypass surgery and aortic surgery.


Readmission rates after major elective surgery are high across national academic centers. Center volume, SOI, and need for transitional care after discharge are factors associated with readmission and may be used to identify patients at high risk of readmission and hospital utilization after major surgery.


Readmission Transitional care Elective surgery Race Severity of illness 


Conflict of interest



  1. 1.
  2. 2.
    Gorodeski EZ, Starling RC, Blackstone EH. Are all readmissions bad readmissions? N Engl J Med. 2010;363:297–298.CrossRefPubMedGoogle Scholar
  3. 3.
    Ahmad SA, Edwards MJ, Sutton JM, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012;256:529–537.CrossRefPubMedGoogle Scholar
  4. 4.
    Kassin MT, Owen RM, Perez SD, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215:322–330.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
  6. 6.
    Sutton JM, Hayes AJ, Wilson GC, et al. Validation of the University HealthSystem Consortium administrative dataset: concordance and discordance with patient-level institutional data. J Surg Res. 2014;190:484–490. doi: 10.1016/j.jss.2014.03.044.
  7. 7.
  8. 8.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–1137.CrossRefPubMedGoogle Scholar
  9. 9.
    Singla A, Simons J, Li Y, et al. Admission volume determines outcome for patients with acute pancreatitis. Gastroenterology. 2009;137:1995–2001.CrossRefPubMedGoogle Scholar
  10. 10.
    Macomber CW, Shaw JJ, Santry H, et al. Centre volume and resource consumption in liver transplantation. HPB (Oxf). 2012;14:554–559.CrossRefGoogle Scholar
  11. 11.
    Lucas DJ, Haider A, Haut E, et al. Assessing readmission after general, vascular, and thoracic surgery using ACS-NSQIP. Ann Surg. 2013;258:430–439.CrossRefPubMedGoogle Scholar
  12. 12.
    Martin RC, Brown R, Puffer L, et al. Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab. Ann Surg. 2011;254:591–597.CrossRefPubMedGoogle Scholar
  13. 13.
    Mudge AM, Kasper K, Clair A, et al. Recurrent readmissions in medical patients: a prospective study. J Hosp Med. 2011;6:61–67.CrossRefPubMedGoogle Scholar
  14. 14.
    Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.CrossRefPubMedGoogle Scholar
  15. 15.
    Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg. 2003;238:161–167.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Hong B, Stanley E, Reinhardt S, Panther K, Garren MJ, Gould JC. Factors associated with readmission after laparoscopic gastric bypass surgery. Surg Obes Relat Dis. 2012;8:691–695.CrossRefPubMedGoogle Scholar
  17. 17.
    Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK. Variation in surgical-readmission rates and quality of hospital care. N Engl J Med. 2013;369:1134–1142.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Li LT, Barden GM, Balentine CJ, et al. Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival. Ann Surg. 2014. doi: 10.1097/SLA.0000000000000673.
  19. 19.
    Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, Boult C. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist. 2008;48:495–504.CrossRefPubMedGoogle Scholar
  20. 20.
    Kind AJ, Smith MA, Frytak JR, Finch MD. Bouncing back: patterns and predictors of complicated transitions 30 days after hospitalization for acute ischemic stroke. J Am Geriatr Soc. 2007;55:365–373.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011;183:E391–E402.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States. Ann Surg. 2006;243:281–286.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gregory C. Wilson
    • 1
  • R. Cutler QuillinIII
    • 1
  • Jeffrey M. Sutton
    • 1
  • Koffi Wima
    • 1
  • Joshua J. Shaw
    • 1
  • Richard S. Hoehn
    • 1
  • Ian M. Paquette
    • 1
  • Daniel E. Abbott
    • 1
  • Shimul A. Shah
    • 1
  1. 1.Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Division of Transplant Surgery, Department of SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA

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