Postoperative 30-Day Readmission: Time to Focus on What Happens Outside the Hospital

Melanie S. Morris, MD; Laura A. Graham, MPH; Joshua S. Richman, MD, PhD; Robert H. Hollis, MD; Caroline E. Jones, MD; Tyler Wahl, MD; Kamal M. F. Itani, MD; Hillary J. Mull, PhD; Amy K. Rosen, PhD; Laurel Copeland, PhD; Edith Burns, MD; Gordon Telford, MD; Jeffery Whittle, MD, MPH; Mark Wilson, MD; Sara J. Knight, PhD; Mary T. Hawn, MD, MPH


Annals of Surgery. 2016;264(4):621-631. 

In This Article


Readmission is difficult to predict at the time of discharge despite exhaustive statistical modeling with granular clinical patient-level detail. Preoperative patient factors and postdischarge complications contributed the most to predictive models, but unexplained variance greatly exceeded explained variance. Readmission rate can only be useful as a hospital quality measure to the extent that readmissions could both be predicted and potentially prevented by actions over which hospitals have some influence. Readmission may even have unintended consequences contrary to the original goals of CMS penalty strategies. Therefore, further work needs to be done to identify genuinely modifiable risk factors and truly high-risk groups to design interventions, and the utility of surgical readmission rate as a quality indicator needs to be carefully evaluated.