Readmission after major surgery: effect of the postdischarge environment.
BACKGROUND
Although uncoordinated postdischarge care has been associated with poor clinical outcomes, the effect of discharge to a low healthcare resource area (LHRA) on readmission remains undetermined. We sought to assess how the quality of discharge area health resources impact readmission following major surgery.


METHODS
This cross-sectional study was performed by linking Maryland state data for 2012-2015 to the Agency for Healthcare Research and Quality Area Health-Resource File. Patients undergoing one of 11 common surgical procedures were identified. Multivariable logistic regression was performed to assess the effect of discharge area health resource quality on readmission.


RESULTS
A total of 76,747 patients were identified of which 9.4% were discharged to a high healthcare resource area (HHRA), whereas 81.9% of patients were discharged to an LHRA. Perioperative morbidity and length of stay were comparable between HHRA versus LHRA patients (both P > 0.05). Among all patients, 30-d and 90-d readmission was 6.5% and 12.4%, respectively. On multivariable analysis, discharge to LHRA was independently associated with a 19% (odds ratio = 1.19; 95% CI, 1.01-1.41; P = 0.043) and 18% (odds ratio = 1.18; 95% CI, 1.04-1.33; P = 0.010) greater odds of 30-d and 90-day readmission, respectively.


CONCLUSIONS
Patients discharged to an area characterized by LHRA were more likely to be readmitted at 30 d and 90 d following index discharge.
['Cerullo|Marcelo|M|', 'Gani|Faiz|F|', 'Chen|Sophia Y|SY|', 'Canner|Joseph K|JK|', 'Pawlik|Timothy M|TM|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D003430:Cross-Sectional Studies D005260:Female D006295:Health Resources D054625:Healthcare Disparities D006801:Humans D016015:Logistic Models D008297:Male D008396:Maryland D008875:Middle Aged D010351:Patient Discharge D010359:Patient Readmission D011785:Quality Assurance, Health Care D019984:Quality Indicators, Health Care D012189:Retrospective Studies D012307:Risk Factors D013514:Surgical Procedures, Operative
Readmission Postdischarge care Surgical complications