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Arch Surg. 2012 Nov;147(11):1000-7. doi: 10.1001/2013.jamasurg.114.

Association of postdischarge complications with reoperation and mortality in general surgery.

Abstract

OBJECTIVES:

To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures.

DESIGN:

Retrospective cohort study.

SETTING:

American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files.

PATIENTS:

A total of 551,510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting.

MAIN OUTCOME MEASURES:

Postdischarge complications, reoperation, and mortality.

RESULTS:

Of 551,510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use.

CONCLUSIONS:

The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.

PMID:
23165614
DOI:
10.1001/2013.jamasurg.114
[Indexed for MEDLINE]

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