Presentation Authors: David-Dan Nguyen*, Sabrina A. Harmouch, Alexander Putnam Cole, Ashwin Ramaswamy, Stuart R. Lipsitz, Quoc-Dien Trinh, Boston, MA, Naeem Bhojani, Montreal, Canada
Introduction: The use of hospital-readmission rates as a hospital quality metric has been debated as hospitalsâ€™ post-surgical readmission rates may be more due to patient factors (case mix) compared to hospital factors. It is not known whether a similar trend is present in advanced endoscopic procedures. We therefore sought to evaluate the contribution of individual hospitals on the patient-level probability of readmission after a typical high-risk endoscopic procedure, percutaneous nephrolithotomy (PCNL).
Methods: Using the Nationwide Readmission Database, we identified non-elective 30-day readmissions following PCNL in U.S. hospitals in 2014. Using a multilevel mixed effects model, we estimated the influence of hospital and clinical variables on patients&[prime] odds of readmission. A hospital-level random effects term was used to estimate the contribution of unmeasured hospital characteristics on their patients&[prime] probability of readmission. In order to assess the relative contribution of each group on the predicted probability readmissions, a pseudo R-squared was calculated for predictor variables.
Results: For a weighted sample of 6,974 patients who received PCNL at 485 hospitals, the 30-day readmission rate was 8.5% (95% CI 7.4 - 9.7). In our adjusted model, hospital characteristics such as surgical volume were not associated with increased likelihood of readmission. Individual hospitals contributed marginally to their patients&[prime] probability of readmission. Patient-level characteristics explained far more of the variability in readmissions than hospital characteristics (R squared 0.53963 vs 0.00305).
Conclusions: Compared to patient-level characteristics, hospital characteristics contributed minimally to a model predicting patient-level probability of readmission. These findings underscore the potential limitations of 30-day post-discharge readmissions to evaluate hospital quality of care.
Source of Funding: Brigham Research Institute, Bruce A. Beal and Robert L. Beal Surgical Fellowship, Conquer Cancer Foundation, Defense Health Agency, Intuitive Surgical, Prostate Cancer Foundation, Vattikuti Urology Institute.