Using a modified Delphi process, a panel of 14 experts reviewed 30-day postoperative readmissions from fiscal years 2008 through 2014 associated with surgeries performed at a Veterans Affairs medical center. The experts included physicians and nonphysicians from the VA and private-sector institutions.
Researchers conducted the consensus process from January through May 2017, after which they completed the analysis of the data.
Over three Delphi rounds, the 14 experts achieved consensus on 50 reasons for readmission.
Readmissions with diagnoses of the following were associated with surgical quality and accounted for 64 percent of readmissions:
• Infection
• Sepsis
• Pneumonia
• Hemorrhage/hematoma
• Anemia
• Ostomy complications
• Acute renal failure
• Fluid/electrolyte disorders
• Venous thromboembolism
Thus, around 36 percent of readmissions were likely not tied to surgical quality.
The proportion of readmissions that were not associated with surgical quality varied by procedure — ranging from 21 percent of readmissions after lower-extremity amputations to 47 percent of readmissions after cholecystectomy.
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