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.
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Article info
Publication history
Published online: January 09, 2019
Accepted:
August 21,
2018
Received in revised form:
August 18,
2018
Received:
June 19,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
