Tuesday, November 20, 2012

Duh? Postoperative complications lead to readmissions

God knows I’ve written more than my share of papers that the Nobel Prize Committee has rightfully chosen to ignore. I understand that academicians need to publish in order to keep their jobs. Writing a paper is hard work and I don’t really want to demean it.

A paper reports that complications of surgery are linked to increased rates of readmission, and this seems rather obvious to me. It got a lot of media attention, and comment is needed.

The study, published in the Journal of the American College of Surgeons, looked at the records of over 1400 patients who had general surgical operations and found that 163 (11.3) were readmitted within 30 days of discharge.

The authors make some good points such as readmissions were not related to age, race, sex, or certain co-morbidities such as diabetes, smoking status, COPD, ascites, hypertension, steroid use, unintentional preoperative weight loss, history of bleeding disorders or renal disease. Readmissions were significantly more apt to occur if patients had preoperative dyspnea, open wounds or disseminated cancer.

But the main findings that readmissions were due to complications and the more complications a patient had, the more likely he was to have been readmitted, are not exactly earth-shattering.

The press release and articles accompanying the paper’s publication were a little over the top.

Here are some quotes from a few of the many articles about this research:

From the American College of Surgeons website: Findings published in the Journal of the American College of Surgeons lead researchers to devise a patient safety plan to decrease complications for the benefit of patients and hospitals.

From a site called Redorbit: [The surgeon-author] reported that the results of this investigation provided a framework for his research team to develop a simple complication-prevention plan that minimizes the risk of surgical patients developing complications.  

No such plan is mentioned in the paper.

From Infection Control Today: This patient safety approach includes engaging the postoperative care team to start transition-of-care planning early—especially for high risk patients—to encourage early discharge from the hospital. This too is not specifically stated in the paper nor is it supported by the data. In fact, early discharge might result in more readmissions. Who knows?

Incidentally, the press release, in most cases printed verbatim by the medical news websites, was wrong about the data forming the basis of the study. It says, “Researchers conducting this retrospective study analyzed patient records from hospitals that were enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), which is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of care in private sector hospitals. Data from Emory University Hospital was merged with ACS NSQIP data to identify unplanned readmissions.” Not so. The paper included patients who were operated on only at Emory University Hospital.

Slight digression: Even if readmission rates were not increased by complications, I would be in favor of a plan to reduce them.

One of the reasons I am skeptical about a lot of things is that when you look into the details, you often find that the “spin” produced by stories about a research paper is not always matched by its content.

I’m not the only one. A French study on the PLoS One website in September found that the spin generated by press releases and abstracts is highly likely to influence news reports about the research and overstate its beneficial effects.

I've written before about the need to read the whole paper and not just the abstract. You must be cautious about what is written in the press release too.


Margaret Polaneczky, MD (aka TBTAM) said...

The spinning often starts, I find, with the press release written by PR folks at the researcher's home institution.

Unfortunately, most journals are not freely accessible to the public so they must rely on the media.

I think the problem is getting worse rather than better, don't you?

Skeptical Scalpel said...

Dr. Polaneczky, I agree. The problem of overenthusiastic reporting of the results of research papers is getting worse. There are too many papers of poor quality and too many news outlets looking for stories. It's easier to cut and paste the press release than it is to critically analyze the paper.

Cristy at Living Donor 101 dot com said...

Here, here on both the above comments. After a particular study was published in 2010, headlines screamed "Living kidney donors live longer than general population". As you might guess, that is not at all what the study said (or even examined). Unfortunately the hospital's PR department was far better than the reporters' covering said story, and I'm still correcting people about that mess two years later.

Skeptical Scalpel said...

Send me the link to that paper. I'd love to read it.

Anonymous said...

Dr. Skeptical Scalpel; you should send a copy to Dr. Douglas Farrago [?sp] who authors the Authentic Medicine Gazette. I believe he would applaud your comments.

Skeptical Scalpel said...

I checked out the Gazette. It's amusing. Thanks.

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