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Week of September 16, 2013


ER visits after surgery: Study finds high rate among seniors

Nearly one in five older adults who have common operations will end up in the emergency department within a month of their hospital stay, a new study finds — a surprisingly high number found in the first national look at the issue.

What’s even more surprising? The wide variation between hospitals, in keeping their older surgery patients from needing emergency care after surgery on their hearts, hips, backs, colons and major blood vessels. Some hospitals had four times the rate of post-surgery emergency care for their patients, compared with others.

In fact, the Medical School team that performed the research with funding from the National Institutes of Health suggests that hospitals could be graded based on their performance on this measure.

But, they note in their paper in the September issue of the journal Health Affairs, further study is needed before post-surgical emergency visits join such measures as hospital readmissions and infections in assessing the quality of hospital care.

The new findings come from an analysis of Medicare data from nearly 2.4 million adults who had at least one of six common operations in a three-year period. Just over 17 percent had one, and more than 4 percent had two or more, ED visits within 30 days of leaving the hospital.

Not only was emergency care common for seniors after surgery — it was also a key route back to a hospital bed. More than half of the patients who sought emergency care ended up being readmitted to the hospital directly from the ED.

Since Medicare now pays hospitals less if they have high readmission rates, and reports those rates publicly, health teams nationwide have ramped up their efforts to make sure hospital patients get support that will keep them from coming back in the “revolving door.” The new study suggests those teams should focus on ways to keep surgery patients from experiencing emergencies after they go home.

“This research is a high-altitude look at this problem, and suggests that we should really be doing more investigation into what is driving the frequency with which patients need to come into the emergency department,” says Dr. Keith Kocher, the study’s lead author and a U-M emergency physician.


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