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Care fragmentation is associated with increased short-term mortality during postoperative readmissions: A systematic review and meta-analysis.

Abstract：

BACKGROUND:Recent trends toward regionalization of complex surgical procedures may increase the risk for care fragmentation during readmissions. Conflicting conclusions have been reported regarding risk factors and consequences of nonindex readmissions (ie, readmission to a separate hospital than the one where surgery was originally performed). We seek to perform a comprehensive review of existing literature. METHODS:Four electronic databases were searched to identify all eligible studies examining the risk factors and outcomes of postoperative nonindex readmission. The pooled odds ratio and 95% confidence interval were calculated using a random-effects model. RESULTS:A total of 444 studies were retrieved from database searches and 23 were included after applying eligibility criteria. Nonindex readmissions constituted 10%-47% of 30-day readmissions. Risk factors for nonindex readmission predominantly represented proxy variables for patient care access that may not be modifiable, such as residing in a location further away from the original hospital, being older in age, living in rural areas, and having lower income. Nonindex readmissions occurred more commonly under urgent conditions. Ten of the 14 studies that employed short-term mortality as the primary outcome concluded that nonindex readmissions were significantly associated with higher mortality after adjusting for available confounders. CONCLUSION:The findings of the current study suggest that nonindex readmission is a common phenomenon after surgery and is associated with increased mortality. Further studies are required to evaluate whether enhancing health information continuity between hospitals would be helpful for mitigating the adverse consequences of care fragmentation.

journal_name

Surgery

journal_title

Surgery

authors

Juo YY,Sanaiha Y,Khrucharoen U,Chang BH,Dutson E,Benharash P

doi

10.1016/j.surg.2018.08.021

subject

Has Abstract

pub_date

2019-03-01 00:00:00

pages

501-509

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(18)30557-9

journal_volume

165

pub_type

杂志文章,meta分析

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Care fragmentation is associated with increased short-term mortality during postoperative readmissions: A systematic review and meta-analysis.