• Kamil Hanna, Mohamad Chehab, Letitia Bible, Samer Asmar, Michael Ditillo, Lourdes Castanon, Andrew Tang, and Bellal Joseph.
• Division of Trauma, Critical Care, Burn, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
• Ann. Surg. 2023 Jan 1; 277 (1): 9310093-100.

ObjectiveCompare EGS patient outcomes after index and nonindex hospital readmissions, and explore predictive factors for nonindex readmission.BackgroundReadmission to a different hospital leads to fragmentation of care. The impact of nonindex readmission on patient outcomes after EGS is not well established.MethodsThe Nationwide Readmissions Database (2017) was queried for adult patients readmitted after an EGS procedure. Patients were stratified and propensity-matched according to readmission destination: index versus nonindex hospital. Outcomes were failure to rescue (FTR), mortality, number of subsequent readmissions, overall hospital length of stay, and total costs. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.ResultsA total of 471,570 EGS patients were identified, of which 79,127 (16.8%) were readmitted within 30 days: index hospital (61,472; 77.7%) versus nonindex hospital (17,655; 22.3%). After 1:1 propensity matching, patients with nonindex readmission had higher rates of FTR (5.6% vs 4.3%; P < 0.001), mortality (2.7% vs 2.1%; P < 0.001), and overall hospital costs [in $1000; 37 (27-64) vs 28 (21-48); P < 0.001]. Nonindex readmission was independently associated with higher odds of FTR [adjusted odds ratio 1.18 (1.03-1.36); P < 0.001]. Predictors of nonindex readmission included top quartile for zip code median household income [1.35 (1.08-1.69); P < 0.001], fringe county residence [1.08 (1.01-1.16); P = 0.049], discharge to a skilled nursing facility [1.28 (1.20-1.36); P < 0.001], and leaving against medical advice [2.32 (1.81-2.98); P < 0.001].ConclusionOne in 5 readmissions after EGS occur at a different hospital. Nonindex readmission carries a heightened risk of FTR.Level Of EvidenceLevel III Prognostic.Study TypePrognostic.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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