Clinical Science| Volume 207, ISSUE 6, P855-862, June 2014

Patient experiences after hospitalizations for elective surgery

Published:October 18, 2013DOI:



      Little is known from patients' perspective about the quality of postdischarge care and the causes of rehospitalization after elective surgery.


      A prospective observational cohort study was conducted.


      Of 400 patient participants, 374 completed the 30-day follow-up questionnaire (completion rate, 94%). Half of all unplanned rehospitalizations (experienced by 13% of patients) and nonrehospitalization emergency department visits (experienced by 6%) occurred within 10 days of discharge. Patients used emergency departments and were rehospitalized at facilities near their homes (mean distance traveled, 12.1 mi). The most common primary reason for rehospitalization was postoperative complications, according to patient report, clinical records, and administrative data. Poor perceived care coordination was associated with higher readmission risk.


      Patients perceive surgical complications as dominating the reasons for rehospitalizations after elective surgery. Strategies to improve care quality around elective surgery at referral centers should target the discharge process and the coordinated management of postoperative complications through care received at regional hospitals.


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      1. Centers for Medicare and Medicaid Services. Readmissions Reduction Program. Available at: Accessed November 8, 2012.

      2. Horwitz LI, Partovian C, Lin Z, et al. Hospital-wide (all-condition) 30-day risk-standardized readmission measure: Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation. Available at: Accessed November 11, 2012.

        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Sellers M.M.
        • Merkow R.P.
        • Halverson A.
        • et al.
        Validation of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) new readmission variables.
        J Am Coll Surg. 2012; 215: S98
        • Kassin M.T.
        • Owen R.M.
        • Perez S.D.
        • et al.
        Risk factors for 30-day hospital readmission among general surgery patients.
        J Am Coll Surg. 2012; 215: 322-330
        • Selby J.V.
        • Beal A.C.
        • Frank L.
        The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda.
        JAMA. 2012; 307: 1583-1584
        • Sharma G.
        • Kuo Y.-F.
        • Freeman J.
        • et al.
        Comanagement of hospitalized surgical patients by medicine physicians in the United States.
        Arch Intern Med. 2010; 170: 363-368
        • Arbaje A.I.
        • Wolff J.L.
        • Yu Q.
        • et al.
        Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries.
        Gerontologist. 2008; 48: 495-504
        • Auerbach A.D.
        • Katz R.
        • Pantilat S.Z.
        • et al.
        Factors associated with discussion of care plans and code status at the time of hospital admission: results from the Multicenter Hospitalist Study.
        J Hosp Med. 2008; 3: 437-445
      3. Agency for Healthcare Research and Quality. Clinical classifications software (CCS) for ICD-9-CM. Available at: Accessed November 11, 2012.

        • Oster A.
        • Bindman A.B.
        Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations.
        Med Care. 2003; 41: 198-207
        • Galloway S.C.
        • Graydon J.E.
        Uncertainty, symptom distress, and information needs after surgery for cancer of the colon.
        Cancer Nurs. 1996; 19: 112-117
        • Kazaure H.S.
        • Roman S.A.
        • Sosa J.A.
        Association of postdischarge complications with reoperation and mortality in general surgery.
        Arch Surg. 2012; 147: 1000-1007
        • Beauregard L.
        • Pomp A.
        • Choiniere M.
        Severity and impact of pain after day-surgery.
        Can J Anaesth. 1998; 45: 304-311
        • Cohen M.E.
        • Bilimoria K.Y.
        • Ko C.Y.
        • et al.
        Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery.
        J Am Coll Surg. 2009; 208: 1009-1016
        • Joynt K.E.
        • Jha A.K.
        Thirty-day readmissions—truth and consequences.
        N Engl J Med. 2012; 366: 1366-1369
        • van Walraven C.
        • Bennett C.
        • Jennings A.
        • et al.
        Proportion of hospital readmissions deemed avoidable: a systematic review.
        Can Med Assoc J. 2011; 183: E391-E402
        • Frankl S.E.
        • Breeling J.L.
        • Goldman L.
        Preventability of emergent hospital readmission.
        Am J Med. 1991; 90: 667-674
        • Benbassat J.
        • Taragin M.
        Hospital readmissions as a measure of quality of health care: advantages and limitations.
        Arch Intern Med. 2000; 160: 1074-1081
        • Ghaferi A.A.
        • Birkmeyer J.D.
        • Dimick J.B.
        Variation in hospital mortality associated with inpatient surgery.
        N Engl J Med. 2009; 361: 1368-1375
        • Ghaferi A.A.
        • Osborne N.H.
        • Birkmeyer J.D.
        • et al.
        Hospital characteristics associated with failure to rescue from complications after pancreatectomy.
        J Am Coll Surg. 2010; 211: 325-330
        • Hansen L.O.
        • Young R.S.
        • Hinami K.
        • et al.
        Interventions to reduce 30-day rehospitalization: a systematic review.
        Ann Intern Med. 2011; 155: 520-528
        • Clancy C.M.
        • Slutsky J.R.
        A progress report on AHRQ's effective health care program.
        Health Serv Res. 2007; 42 (xi-xix)
      4. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States 2011: with special feature on socioeconomic status and health. Available at: Accessed November 12, 2012.