Medicare post-discharge deaths and readmissions following elective surgery

BACKGROUND: The frequency of 90-day, postdischarge deaths and readmissions in Medicare patients undergoing elective surgical procedures has not been well studied. METHODS: The Medicare MedPar database for 2009 to 2010 was used to develop inpatient risk-adjusted, postoperative length-of-stay (RApoLOS) prediction models for live discharges in 21 categories of elective operations. Moving average control charts were used in each category to define RApoLOS outliers (>3 sigma). The relationships between RApoLOS outliers and all postdischarge deaths and readmissions within 90 days of discharge were assessed. RESULTS: The inpatient mortality rate was .5%. Of 2,054,189 live discharges, 147,292 (7%) were RApoLOS outliers. There were 14,657 postdischarge deaths (. 7%) and 187,566 readmissions (9%). RApoLOS outliers had a 3.5% death rate and a 17% rate of readmission, while those found not to be RApoLOS outliers had a .5% death rate and a 9% readmission rate (P < .0001). CONCLUSIONS: RApoLOS outliers have increased rates of postdischarge deaths and readmissions. (C) 2014 Elsevier Inc. All rights reserved.