• Donald E Fry, Michael Pine, and Gregory Pine.
• Michael Pine & Associates, 1 East Wacker Drive, #1201, Chicago, IL 60601, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA. Electronic address: dfry@consultmpa.com.
• Am. J. Surg. 2014 Mar 1;207(3):326-30; discussion 330.

BackgroundThe frequency of 90-day, postdischarge deaths and readmissions in Medicare patients undergoing elective surgical procedures has not been well studied.MethodsThe Medicare MedPar database for 2009 to 2010 was used to develop inpatient risk-adjusted, postoperative length-of-stay (RApoLOS) prediction models for live discharges in 21 categories of elective operations. Moving average control charts were used in each category to define RApoLOS outliers (>3σ). The relationships between RApoLOS outliers and all postdischarge deaths and readmissions within 90 days of discharge were assessed.ResultsThe inpatient mortality rate was .5%. Of 2,054,189 live discharges, 147,292 (7%) were RApoLOS outliers. There were 14,657 postdischarge deaths (.7%) and 187,566 readmissions (9%). RApoLOS outliers had a 3.5% death rate and a 17% rate of readmission, while those found not to be RApoLOS outliers had a .5% death rate and a 9% readmission rate (P < .0001).ConclusionsRApoLOS outliers have increased rates of postdischarge deaths and readmissions.Copyright © 2014 Elsevier Inc. All rights reserved.

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