Predictors of unplanned hospital readmission after non-cardiac surgery in Singapore: a 2-year retrospective review

Abstract

Introduction: Unplanned hospital readmissions after surgery contribute significantly to healthcare costs and potential complications. Identifying predictors of readmission is inherently complex and involves an intricate interplay between medical factors, healthcare system factors and sociocultural factors. Therefore, the aim of this study was to elucidate the predictors of readmissions in an Asian surgical patient population. Methods: A two-year single-institution retrospective cohort study of 2744 patients was performed in a university-affiliated tertiary hospital in Singapore, including patients aged 45 and above undergoing intermediate or high-risk non-cardiac surgery. Unadjusted analysis was first performed, followed by multivariable logistic regression. Results: Two hundred forty-nine patients (9.1%) had unplanned 30-day readmissions. Significant predictors identified from multivariable analysis include: American Society of Anaesthesiologists (ASA) Classification grades 3 to 5 (adjusted OR 1.51, 95% CI 1.10–2.08, p = 0.01), obesity (adjusted OR 1.66, 95% CI 1.18–2.34, p = 0.04), asthma (OR 1.70, 95% CI 1.03–2.81, p = 0.04), renal disease (OR 2.03, 95% CI 1.41–2.92, p < 0.001), malignancy (OR 1.68, 95% CI 1.29–2.37, p < 0.001), chronic obstructive pulmonary disease (OR 2.46, 95% CI 1.19–5.11, p = 0.02), cerebrovascular disease (OR 1.73, 95% CI 1.17–2.58, p < 0.001) and anaemia (OR 1.45, 95% CI 1.07–1.96, p = 0.02). Conclusion: Several significant predictors of unplanned readmissions identified in this Asian surgical population corroborate well with findings from Western studies. Further research will require future prospective studies and development of predictive risk modelling to further address and mitigate this phenomenon.