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Readmission to same hospital boosts survival after surgery

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Patients with complications after major surgery are more likely to survive if they are readmitted to the same hospital, according to a new large-scale study, which raises questions about the current drive to reorganise care into regional centres further from patients’ homes.

The US research, published in The Lancet, found patients were 26% more likely to live if they returned to the hospital where their original operation took place, compared to those admitted to a different hospital.

The authors suggest thousands of lives could be saved each year if patients returned to the care of their original surgical team. They claimed their findings challenged health policy in the US and UK based on the idea patients always fare better if sent to specialist centres.

“Our findings suggest that maintaining continuity of care when readmissions occur is a more important predictor of survival than other established surgical quality measures”

Benjamin Brooke

They examined data from more than nine million US patients on the nation’s Medicare health insurance scheme, who underwent 12 common high-risk operations.

The number of patients readmitted to hospital with complications within 30 days of their operation ranged from 5.6% of knee replacements to 22% of those who underwent an oesophagectomy – removal of all or part of the oesophagus.

Many were readmitted to the same hospital where their procedure took place, ranging from two thirds of those who had coronary artery bypass surgery to 83% of patients who underwent a colectomy – removal of all or part of the colon.

Significantly, those returned to the same hospital were 26% less likely to die within 90 days than those who went to a different hospital, even after taking into account quality measures that can affect mortality rates such as the size of the hospital, teaching status and volume of procedures.

Lead author Dr Benjamin Brooke, from the University of Utah in Salt Lake City, said patients were increasingly travelling long distances to be treated at hospitals known for providing high quality care.

“The assumption has been that if patients need readmission for complications they can seek care at local hospitals without compromising outcomes,” he said.

“However, our findings suggest that maintaining continuity of care when readmissions occur is a more important predictor of survival than other established surgical quality measures,” he added.

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