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Colon Surgery Linked to High Readmission Rates | Orange City Malpractice Attorney

Colon Surgery Linked to High Readmission Rates

Nearly a fourth of privately insured colon surgery patients are readmitted to the hospital within three months of discharge, most due to complications from surgical site infections, according to a new study.

And the cost is roughly $9,000 per readmission, say researchers with Johns Hopkins University School of Medicine. The study’s authors say this is a major area in health care for quality improvement and cost reduction.

Hospital readmission rates are a major financial burden on the health care system. These findings account for $300 million in readmission costs annually in the U.S. for colorectal surgery alone.

“Readmissions after surgery are common and they burden the health care system with exorbitant costs,” says Dr. Martin A. Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine.

Some readmissions are unavoidable, Markary said, but often they are the result of poor coordination of medical care. With a rate of 23 percent, the opportunity for improvement is huge, he said.

Indeed, hospital readmissions are costly to the patient and the medical system and they delay patient recovery, said study leader Dr. Elizabeth Wick, an assistant professor of surgery at Johns Hopkins. Such readmissions also victimize some patients multiple times, she said.

Using data from 8 states from BlueCross BlueShield plans, Makary, Wick and their colleagues reviewed records of 10,882 patients who underwent colorectal surgery between 2002 and 2008.

Their findings include:
11.4 percent of patients were readmitted to the hospital within 30 days of discharge
Another 12 percent were readmitted between days 31 and 90
Nearly 7 percent, or about 725 patients, were readmitted two or more times within the first three months after discharge.

Colorectal surgery patients are at increased risk for readmission due to the location and complexity of these procedures. Many of these patients suffer from a postsurgical infection or dehydration as the digestive system recovers from surgery. Stoma or ostomy complications are also very common as a stoma is often needed to divert the intestinal tract outside the body.

Patients with a stoma are three times as likely to be readmitted within 30 days, and those with surgical-site infections are twice as likely, researchers learned. Patients in the study needed colorectal surgery primarily due to cancer or diverticulitis, a chronic inflammation of the intestines. Almost 19 percent of patients in the study contracted a surgical-site infection within 30 days of their operations.

Just a 5 percent reduction in surgical-site infections would have a major impact on readmission rates and associated costs, said Wick.

Makary says some hospitals are starting to have nurses follow up with patients by phone in the days after discharge. Those at high risk for readmission receive home visits from a nurse. Both interventions are less costly than the cost of a new hospital stay.

Many readmissions may be related to patients falling through the cracks, Makary said. These patients sometimes get lost in the process of setting follow-up appointments, don’t know what a normal recovery should be, lack the correct phone numbers to call for questions or are discharged with the wrong medications.

And some patients may be leaving the hospital too early, Makary suggests, adding that a bit of extra care on the front end might prevent costly readmissions.

The Centers for Medicare and Medicaid Services has targeted readmission rates after hospitalization for certain medical conditions as a factor in determining how much a hospital should be paid for treatment. Starting in 2013, hospitals with higher than expected risk-adjusted 30-day readmission rates for patients with pneumonia, congestive heart failure and heart attacks will incur financial penalties. The public is also being asked to report readmission rates.

Health care experts anticipate that patients with other diagnoses, including those undergoing colorectal surgery, will be incorporated into this pay-for-performance measure in the future.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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