Factors associated with unplanned readmission after elective gastroenterological surgery: An analysis of 1,824 participants with clean-contaminated wounds enrolled in two randomized controlled trials for the prevention of surgical site infection.

BACKGROUND: Unplanned readmission is a fundamental metric of quality of care associated with significant clinical and financial burden. Surgical site infection (SSI) is one of the most common clinical indications for unplanned readmission following surgery. This study assessed factors associated with unplanned readmission within 30 days post-discharge after elective gastroenterological surgery under the implementation of SSI prevention bundles. METHODS: A total of 1,973 patients enrolled in two previous randomized controlled trials to evaluate the efficacy of intraoperative interventions for SSI prevention after gastroenterological surgery with clean-contaminated wounds were eligible for inclusion in the present study. The factors associated with unplanned readmission were assessed using univariate and multivariate analyses. RESULTS: Seventy-one (3.9%) of the 1,824 patients who underwent elective gastroenterological surgery experienced unplanned readmission within 30 days after discharge. One hundred and thirty-one (7.2%) patients developed incisional SSI, and 122 (6.7%) developed organ/space SSI. Of 122 patients who developed organ/space SSI, 106 (86.9%) developed it during the index hospital stay, and 16 (13.1%) developed it after discharge. Postoperative ileus (23.9%) was the most common cause of readmission, followed by organ/space SSI (22.5%), and dehydration/acute kidney injury (8.5%). A multivariate logistic regression analysis revealed that pulmonary disorder (OR 2.09; 95% CI1.26-3.49, p=0.005) was significantly associated with unplanned readmission. CONCLUSIONS: This study showed that organ/space SSI and postoperative ileus were important causes of unplanned readmission and pulmonary disorders were a risk factor for unplanned readmission within 30 days following discharge after elective gastroenterological surgery.