Junior residents were much more likely to report that the number of resources available is overwhelming. Asked to choose a single tool that would most improve their case preparation, residents chose, in almost equal numbers, a database of surgical videos, a resident-oriented website for graduated understanding, and a tool for finding “top-rated” resources.
Explore This IssueApril 2016
“Case preparation is certainly not consistently rated as effective or efficient by residents right now, and while there does seem to be some progression through residency, there seems to be room for improvement in that at all levels,” Dr. Jabbour said. “There does seem to be some need for future resource development, but at the same we would like to improve the way we’re using the resources we already have.”
Thirty-Day Hospital Readmission Following Otolaryngology Surgery
An analysis of 30-day readmissions across more than 58,000 otolaryngology inpatient surgery discharges and a variety of hospital types has found that patient factors—and not hospital-level factors such as whether the surgery was performed at an academic center or not—are the main driving force behind whether or not a patient will be readmitted.
The analysis, from investigators at Washington University in St. Louis, Mo., used information from the State Inpatient Database, which is available through the U.S. Healthcare Cost and Utilization Project. In that database, patients are given a unique identifier, allowing them to be tracked over time, which overcomes a limitation of other literature—losing track of patients if they are readmitted at a center other than the original location of the surgery.
Researchers looked at the readmissions of California residents from 2008 to 2010. The data set included 58,748 discharges, approximately 500 of which were excluded because the original length of stay was more than 90 days or the surgery was done at a center with fewer than 10 otolaryngology admissions. The overall readmission rate was 8.1%, said Evan Graboyes, MD, a resident at the Washington University, who presented the findings.
Although univariate analysis showed that readmission rates were somewhat higher in teaching hospitals than non-teaching hospitals and in hospitals that serve a disproportionate share of low-income patients, those associations disappeared upon multivariate analysis, he said. “Variation in readmission rates between hospitals is driven by patient factors, not hospital factors,” Dr. Graboyes said.
Facial plastics and trauma (OR = 0.54) and endocrine procedures (OR = 0.77) were less likely to result in readmissions. Patients on Medicaid (OR = 1.27) or Medicare (OR = 1.54) were more likely to be readmitted, as were those with certain co-morbidities, including anemia, chronic lung disease, and renal failure. Surgical complications during the original hospital stay were not associated with a higher readmission risk on multivariate analysis, but medical complications during the original stay were (OR = 1.52). The highest risks for readmission were seen for patients discharged with home healthcare (OR = 2.23) or to a skilled nursing facility (OR = 2.21).