Prediction models of Medicare 90-day postdischarge deaths, readmissions, and costs in bowel operations

Abstract Background The 90-day postdischarge morbidity and mortality rates following elective and emergent bowel surgery remain poorly defined. Methods The 2009 to 2011 Medicare inpatient files for patients undergoing elective and emergent small and large bowel operations in 1,024 hospitals that passed present-on-admission coding accuracy standards had prediction models designed for inpatient mortality, prolonged postoperative length of hospital stay (prLOS), 90-day postdischarge mortality and readmissions, and total hospital costs. Results Of 118,758 patients studied, there was a 4.7% inpatient mortality rate and 7.3% prLOS among live discharges. An additional 7,586 deaths and 26,969 readmissions occurred within 90 days of discharge. Prolonged preoperative and prolonged postoperative hospitalizations were significant ( P < .0001) variables in predicting postdischarge deaths and readmissions. Total hospital costs were increased by over $18,000 per adverse outcome. Conclusion Postdischarge deaths and readmissions are more common than inpatient adverse events of death and prLOS in elective and emergent Medicare large and small bowel operations.