Using ACS NSQIP to Predict Readmission Rates in Surgical Oncology Patients
The University of Texas at Austin Dell Medical School
Introduction: Reducing preventable hospital readmissions is important for both patients, hospital administrators, providers, and policymakers seeking to improve health care and lower costs. This study was done as part of a quality improvement project by second year medical students at The University of Texas at Austin Dell Medical School. The goal was to determine the risk factors associated with readmission rates in surgical oncology patients and to propose an intervention to help reduce preventable readmissions. Methods: A prospective cohort of surgical oncology patients was identified in 2017-2018. Readmission risk scores were calculated using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) patients admitted to the surgical oncology service. Over the span of 8 months, these patients were observed for actual readmission after surgery. If readmitted, the reason for readmission and days to readmission were noted. The patient’s age, medical condition, surgical procedure, complications, and discharge location were also recorded. Results: Of the 95 patients in the cohort, 16 were readmitted. Of the 16 readmitted, 13 had an ACS NSQIP readmission risk score of greater than 13%, compared to 13 of the 79 not readmitted. An ACS NSIP score of 13% was an adequately sensitive (81.3%) and specific (83.5%) threshold. The most common reasons for readmission were gastrointestinal obstruction leading to nausea and vomiting and post-operative infection or hematoma formation. The average number of days to readmission was 8.4 days. Conclusion: The average number of days between the discharge and readmission dates is a little over a week, which is prior to the typical 2-week follow-up appointment. This means that higher risk patients do not receive intervention early enough to correct the reason for readmission. Proposed interventions for high-risk patients include pre-discharge education on complications and proper wound care, early postoperative follow-up, and telephone-surveillance at certain time periods after discharge.