Mull HJ, et al. - The researchers aimed to establish expert consensus on if reasons for postoperative readmission are associated with the quality of surgery in the index admission. They noted that about one-third of postoperative readmissions do not reflect problems with surgical quality. They suggested restricting the definition of postoperative readmission to consensus-defined diagnosis codes in order to obtain a more useful quality measure.

Methods

• In a modified Delphi process, a panel of 14 experts in medical and surgical readmissions comprising physicians and nonphysicians from Veterans Affairs (VA) and private-sector institutions reviewed 30-day postoperative readmissions from fiscal years 2008 through 2014 associated with inpatient surgical procedures performed at a VA medical center between October 1, 2007, and September 30, 2014.
• From January through May 2017, the consensus process was conducted.
• Based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, reasons for readmission were grouped into categories.
• Panelists were given the proportion of readmissions coded by each reason and median (interquartile range) days to readmission.
• The question, they answered was, “Does the readmission reason reflect possible surgical quality of care problems in the index admission?” on a scale of 1 (never related) to 5 (directly related) in 3 rounds of consensus building.
• In May 2017, the consensus process was completed and in June 2017, data were analyzed.
• Main outcomes and measures included consensus on proportion of ICD-9–coded readmission reasons that reflected quality of surgical procedure.

Results

• The 14 panelists achieved consensus on 50 reasons for readmission in 3 Delphi rounds; between rounds 1 and 2, 12 panelists also completed group telephone calls.
• Readmissions in relation to diagnoses of infection, sepsis, pneumonia, hemorrhage/hematoma, anemia, ostomy complications, acute renal failure, fluid/electrolyte disorders, or venous thromboembolism were considered associated with surgical quality; these accounted for 25,521 of 39,664 readmissions (64% of readmissions; 7.5% of 340,858 index surgical procedures).
• In this study, the proportion of readmissions that were not considered to be associated with surgical quality varied by procedure, ranging from to 21% (613 of 2331) of readmissions after lower-extremity amputations to 47% (745 of 1,598) of readmissions after cholecystectomy.