Complete Impact of Care Fragmentation on Readmissions Following Urgent Abdominal Operations

  • Yen-Yi Juo
  • Yas Sanaiha
  • Usah Khrucharoen
  • Areti Tillou
  • Erik Dutson
  • Peyman BenharashEmail author
Original Article



Urgent abdominal operations commonly occurred in low-volume hospitals with high failure-to-rescue rates. Recent studies have demonstrated a survival benefit associated with readmission to the original hospital after operation, presumably due to improved continuity of care. It is unclear if this survival benefit persists in low-volume hospitals. We seek to evaluate differences in mortality between readmission to the original hospital and a higher-volume hospital after urgent abdominal operations.


A retrospective cohort study using the National Readmissions Database from 2010 to 2014 was performed. Propensity score-weighted multilevel regression analysis was used to examine the association between readmission destination and mortality after accounting for hospital volume.


A total of 71,551 adult patients who experienced 30-day readmission following urgent abdominal operations were identified, among whom 10,368 (14.5%) were readmitted to a different hospital. Patients with higher baseline comorbidity scores, lower income, less comprehensive insurance coverage, systemic complications, prolonged length of stay, or non-home disposition were more likely to experience readmission to a different hospital. Following stratification by readmission hospital volume and propensity score weighting to adjust for baseline mortality risk differences, readmission to a different hospital is still associated with higher mortality rates than the original hospital.


The adverse outcomes associated with case fragmentation are present even after adjusting for readmission hospital volume. Patients who received urgent abdominal operations at low-volume hospitals should return to the original hospital for concern of care fragmentation.


Care fragmentation Care discontinuity Readmission Abdominal surgery 


Author Contribution

Substantial contribution to the conception or design of the work: Juo, Sanaiha, Tillou, Dutson, Benharash

Acquisition, analysis or interpretation of data: Juo, Sanaiha, Khrucharoen

Drafting the work or critical revision: Juo, Sanaiha, Khrucharoen, Tillou, Dutson, Benharash

Final approval of the version to be submitted: Juo, Sanaiha, Khrucharoen, Tillou, Dutson, Benharash

Agreement to be accountable for all aspects of the work: Juo, Sanaiha, Khrucharoen, Tillou, Dutson, Benharash

Supplementary material

11605_2018_4033_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 26 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Cardiovascular Outcomes Research Laboratories, David Geffen School of MedicineUniversity of California Los Angeles (UCLA)Los AngelesUSA
  2. 2.Department of SurgeryUniversity of California Los Angeles (UCLA)Los AngelesUSA
  3. 3.UCLA Division of Cardiac SurgeryUCLA Center for Health SciencesLos AngelesUSA

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