Simultaneously evaluate postoperative mortality, length of stay (), and readmission.
National Surgical Quality Improvement Program ().
Data from elective general surgical patients were obtained from the 2012 Participant Use File. For each postoperative day, each patient's state was classified as index hospitalization, discharged home, discharged to long‐term care (), readmitted, or dead. Transition rates were estimated using exponential regression, assuming constant rates for specified time periods. These estimates were combined into a multistate model, simulated results of which were compared to observed outcomes.
Age, comorbidities, more complex procedures, and longer index were associated with lower rates of discharge home and higher rates of death, discharge to , and readmission. The longer patients had been discharged, the less likely they were to die or be readmitted. The model predicted 30‐day mortality 0.38 percent (95 percent : 0.36–0.41), index 2.85 days (95 percent : 2.83–2.86), discharge 2.76 percent (95 percent : 2.69–2.82), and readmissions 5.53 percent (95 percent : 5.43–5.62); observed values were 0.39 percent, 2.82 days, 2.87 percent, and 5.70 percent, respectively.
Multistate models can simultaneously predict postoperative mortality, , discharge destination, and readmissions, which allows multidimensional comparison of surgical outcomes.