Prepared surgery patients less likely to boomerang

Key clinical point: The amount and quality of information patients report receiving before an operation and discharge are correlated to how likely patients are to be readmitted after surgery.

Major finding: Patients who felt prepared before surgery had a 30-day readmission rate of 8% vs. 23% for those who did not feel prepared.

Data source: A nationwide online survey of 1,917 people who either had surgery in the past year or were relatives or caregivers of someone who did.

Disclosures: The study authors reported having no relevant financial disclosures.




JACKSONVILLE, FLA. – Patients who report receiving and using materials to help them prepare for surgery and its aftermath are less likely to be readmitted, according to results of a large surgical patient survey.

Readmissions after surgery have become anathema to doctors and hospitals as government and commercial payers ratchet up penalties, but a study presented at the Association for Academic Surgery/Society of University Surgeons Academic Surgical Congress has found that giving patients written instructions, handouts, and videos and directing them to multimedia and online sources can reduce the risk of readmission after surgery by about two-thirds.

Dr. Luke Martin, a general surgery resident at the University of Utah, Salt Lake City, presented results from a nationwide online survey of 1,917 people who either had surgery in the past year or were relatives or caregivers of someone who did.

“We found a direct relationship between the quantity of resources used and the patient-reported feelings of preparedness,” Dr. Martin said. “We found that feeling unprepared or using no resources was associated with an increased 30-day risk of readmission.”

The study analyzed respondents’ feelings of preparedness before surgery and after surgery but before discharge. Those who felt prepared before surgery had a 30-day readmission rate of 8% vs. 23% for those who did not feel prepared. Rates were similar for those who felt prepared after surgery and those who felt unprepared: 9% vs. 23%. The overall readmission rate of 10% “is in line with expected results,” Dr. Martin said. “Using any resource was associated with a 10% rate of readmission, whereas using no resources was associated with a 31% rate of 30-day readmission,” Dr. Martin said.

“The bottom line is that health information resources have not been well studied in surgical patients, and no matter what types of resources we provide patients, sometimes they go out and find their own health information resources and supplements,” Dr. Martin said.

Overall, 64% of respondents said they felt very prepared before and after surgery and before leaving the hospital; 8% felt very unprepared before their operations, and 4% felt that way before leaving the hospital.

Patients who felt prepared were most likely to report being given multiple health information resources before surgery (97% vs. 79%, P less than .001) and before leaving the hospital (91% vs. 85%, P = .02). Resources included face-to-face meetings, written instructions, Internet sites, videos, and smartphone applications.

Patients who reported receiving one or more resources before surgery had rates of feeling prepared exceeding 90%. Those who said they had received three or more resources had almost universal rates of feeling prepared. On the other hand, only about 60% of patients who claimed they did not receive resources before their operations felt prepared.

The researchers also looked at whether survey respondents reported that they actually utilized the resources they were given before their operations or if they sought out resources on their own.

“We found that the very commonly provided written instructions are used by patients less than half the time, 41%, vs. a 90% rate of having them provided,” Dr. Martin said. The converse was true of utilization of Internet resources; only 17% of respondents said they were provided with Internet resources, but 45% said they utilized them.

“We should as providers ensure access to more resources because patients who use more resources or are provided with more resources feel more prepared to transition after surgical procedures, and perhaps we should personalize resources to patients’ preferences, learning styles, and levels of health literacy so that we can ensure they feel prepared to transition before and after their surgical procedure,” Dr. Martin said.

During the discussion, Dr. Dawn Elfenbein of the University of California, Irvine, cautioned against using quantity of information as the only measure. “We give our patients written instructions and websites, and they say they actually don’t use the information because we give them too much and it needs to be better organized,” she said. ”Sometimes accessibility is part of the issue, and quality is also important.”

Dr. Matthew Corriere of Wake Forest University, Winston-Salem, N.C., had another take on patient preparation for surgery. “I think those patients who do not have Internet access are a real goldmine for readmission,” he said.

Dr. Martin and coauthors had no financial relationships to disclose.

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