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Adverse outcomes after discharge: occurrence, treatment and determinants

¹ Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
² Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands

Correspondence to:
Dr P J Marang-van de Mheen, Department of Medical Decision Making, Leiden University Medical Centre, J10-S, PO Box 9600, 2300 RC Leiden, The Netherlands; p.j.marang{at}lumc.nl

ABSTRACT
Objective: (1) to estimate the occurrence of postdischarge adverse outcomes in surgical patients and their treatment; (2) to explore determinants during admission that may influence the occurrence of postdischarge adverse outcomes.

Design: Four weeks after discharge, patients were contacted by telephone and interviewed about: (1) the occurrence of adverse health outcomes after discharge; (2) their treatment and whether readmission or additional surgery was required. Data on the type of surgery and the occurrence of in-hospital adverse outcomes were taken from the routine reporting system.

Setting: Dutch university hospital

Study sample: All 2145 surgical patient admissions in 2003, of whom 1960 (91%) agreed to participate.

Main outcome measures: Percentage of patient admissions with postdischarge adverse outcomes, by type of treatment.

Results: Postdischarge adverse outcomes occurred in 487 patients (25%). Most (76%) of the 554 adverse outcomes were treated by a specialist: 165 (30%) during readmission and 257 (46%) at the outpatient clinic. Postdischarge adverse outcomes were mostly infections (39%). In-hospital adverse outcomes and complex surgical procedures increased the probability for both postdischarge adverse outcomes (odds ratio 1.43 (1.05 to 1.94) and 1.36 (1.02 to 1.82) respectively) and postdischarge adverse outcomes that require readmission (odds ratio 1.59 (1.01 to 2.52) and 1.73 (1.09 to 2.74) respectively).

Conclusions: Patients should be informed at discharge that postdischarge adverse outcomes may occur, in particular if the patient had complex surgical procedures or adverse outcomes during hospitalisation. Since infections were the main type of postdischarge adverse outcomes, more attention should be given on wound treatment by patients and infection prevention after discharge.