Micah Girotti, Sandra Park, Wendy L. Wahl, Mark Hemmila, Peter K. Henke
Surgery, University of Michigan, Ann Arbor, MI.
OBJECTIVES: Medicare now levies financial penalties against hospitals for excessive readmissions. Although intensive post-discharge follow-up has been shown to decrease readmissions in medical patients, evidence-based interventions to decrease readmissions in vascular surgery are scant. We sought to examine the effect of a callback program on readmission rates in patients undergoing major vascular surgery.
METHODS: We instituted a pre-discharge checklist screen and post-discharge callback program in our center for patients undergoing major lower extremity or abdominal vascular surgery. A total of 388 patients were identified in the year prior to (266) and the year after (122) the intervention was initiated. Thirty-day readmission rates, emergency department (ED) visit rates and early clinic visit rates (defined as a clinic visit less than 14 days post-discharge) were calculated and compared between the pre- and post-intervention periods. Major demographic and comorbidities were then used to create a risk-adjusted logistic regression model examining the effect of the interventions on the outcomes.
RESULTS: Pre-intervention 30-day readmission rates were 9.8%, compared to 9% after the intervention (p=0.81). The most common reason for readmission were infectious/wound-related (40.5%), and the incidence did not differ between pre- and post-intervention time periods; additionally, patients with a positive screen for wound concerns at discharge were more likely to be readmitted (p=0.04). Post-operative ED visit rates were identical in the post-intervention group as compared to the pre-intervention group, as were the reasons for presentation. Risk-adjusted logistic regression models bore these trends out, though none reached statistical significance.
CONCLUSIONS: A callback program did not reduce readmissions or direct patients to clinic rather than the ED in a population of patients undergoing major vascular surgery. A focused process for postoperative wound management may yield the highest decrease in readmissions.
AUTHOR DISCLOSURES: M. Girotti: Nothing to disclose; M. Hemmila: Nothing to disclose; P. K. Henke: Nothing to disclose; S. Park: Nothing to disclose; W. L. Wahl: Nothing to disclose.
Posted April 2013