Patients are 26% less likely to die within 90 days of a major surgery if, when they suffer complications, they are readmitted to the same hospital, researchers found in a major analysis of 10 years worth of Medicare data.
Researchers in Utah and New Hampshire analysed the claims of more than 9 million Medicare patients who were readmitted to the hospital within 30 days of complex surgery such as a total hip replacement. They then analysed whether the patient’s death rate was impacted by being admitted to a different hospital than where they underwent surgery.
Using a complex statistical model believed by some economists to bring the large data set closer to the ideal – a randomised study – researchers analysed claims between January 2001 to November 2011. Medicare is the US government health plan that covers adults older than 65, and is the largest health insurer in the country.
The study, “Readmission destination and risk of mortality after major surgery: an observational cohort study,” was published in the UK medical journal the Lancet on Wednesday.
At its core, the study focuses on “continuity of care” – the concept that patients may have better outcomes when they are able to see the same doctor throughout treatment. The data was culled from patients who underwent 12 complex surgeries from five disciplines, such as total hip replacements and partial removal of the oesophagus.
One physician involved in the study said researchers began the year-long data analysis after they hypothesised that a push to regionalise hospitals had an effect on that continuity. In other words, as some hospitals successfully specialised in complex procedures patients traveled longer distances to undergo elective surgeries there, but returned at differing rates if complications arose.
The doctors’ concerns about postoperative care were well founded, as some studies have shown that as many as one in four surgical patients will need to be readmitted to the hospital following a complex surgery.
The study, doctors said, provides data to backup to some of the more anecdotal concerns they have when patients are readmitted to different hospitals. A hospital that originally performed a surgery could have more personal knowledge of patients or of the procedure, one doctor argued.
“Those doctors [at different hospitals] are not going to know all the things that went on in that previous hospitalisation,” said Dr Benjamin Brooke, a surgeon at the University of Utah School of Medicine and a primary author of the study.
Or, more practically, said Dr Justice Dimick of the University of Michigan Health System, some hospitals simply may not have the experience to manage complications of complex, seldom-performed surgeries.
“It’s this issue of: do they have the know-how, the tacit knowledge? Its not in textbooks, it’s clinical intuition. Its tacit knowledge that you gain through experience,” said Dimick. “It happens in everything else, why wouldn’t it be in medicine?”
Patients, by contrast, could have more knowledge of where to turn for help within a hospital system, avoiding a visit to the emergency room.
Surgeons that participated in the study said the research points to the need to create a plan for patients who travel long distances to undergo complex surgeries, and that the risks of readmission to a different hospital should be considered by patients who travel long distances.
“Maybe it means making sure you don’t go too far,” said Dimick. “If there’s a good hospital 30 miles away, and a great one 300 miles away, maybe you go to the good one because you take into [account] getting back to the hospital.” Dimick wrote in support of the study.
The American College of Surgeons, the largest surgeons’ association in the world, was not immediately available for comment.
