As many as 22% of surgical patients experience unexpected complications and must be readmitted for postoperative care, and a new study suggests that returning to the same hospital is important for recovery.
In fact, readmission to a different hospital was associated with a 26% increased risk for dying within 90 days.
The results, published in The Lancet, have implications for patients who take part in domestic medical tourism.
While traveling to international locales to undergo plastic surgery on the cheap gets a lot of attention, many plastic surgery patients may also fly to other parts of the US for surgery with a specific surgeon. The new study, however, did not look at plastic surgery procedures.
“Between 5 to 22 percent of patients were readmitted in our study, depending on the type of surgery,” says lead author Benjamin Brooke, MD, PhD, an assistant professor of surgery at the University of Utah School of Medicine, in a news release. “Our work suggests that striving to maintain continuity of care in the same hospital, and by the same medical team when possible, is critical to achieve the best outcomes should complications arise after surgery.”
Returning to the site where the original operation was done was associated with improved survival regardless of whether it was a large teaching hospital or smaller community hospital, the study showed. Patients fared slightly better when also treated by the same surgical team. The trends held true for patients who underwent a wide range of common operations.
“Most people do not think about the implications of traveling far for an operation,” says Samuel Finlayson, MD, MPH, also a professor and chair of surgery. “As with many healthcare decisions, there are trade-offs to consider. Traveling may confer the best chance of a favorable outcome with surgery, but it may hinder access to optimal care in the event of a serious complication after discharge.”
Have operations done close to home when possible, and if traveling to a destination hospital, stay in the area during recovery, the study authors add. If a patient is readmitted to an outside hospital, “every effort should be made to transfer surgical patients back within 24 hours to their original hospital for postoperative management.”
The researchers examined data from 9,440,503 Medicare patients who were readmitted within 30 days after undergoing any of 12 major surgical procedures between 2001 and 2011. They found that 66% to 83% of patients who had complications were readmitted to the same hospital, and these patients were more likely to survive 90 days after readmission than those who received postoperative treatment at a different hospital.
Better survival was consistent across all surgeries, and ranged from a 44% decrease in risk for death for those who underwent pancreatectomy, to 13% for coronary artery bypass surgery, according to risk-adjusted, inverse probability weighted models. A second statistical method, instrumental variable analysis, showed attenuated results but supported the findings from these models. A randomized trial is needed to prove a causal link.