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Nearly all unplanned readmissions after surgery are associated with new postoperative complications that surface after discharge, according to a  of 346 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program in 2012, published yesterday in the Journal of the American Medical Association. This suggests that readmissions after surgery “are mostly a proxy measure for post-discharge complications, and “in effect penalize hospitals twice for postoperative complications (i.e., other pay for performance programs include postoperative complications such as SSI),” the authors said. The most common overall reasons for unplanned readmission were surgical site infection (19.5%) and obstruction (10.3%). “Identifying clinical interventions to reduce the occurrence of these complications to below current levels has been challenging,” the study notes. “Thus, implementation of a policy penalizing hospitals for readmitting patients with these complications may be ineffective and even potentially counterproductive.” Another  in the journal looked at whether NSQIP improves outcomes and/or reduces costs for Medicare patients relative to nonparticipating hospitals, and found no significant difference between the two groups, with progressively better surgical outcomes over time among both participating and non-participating hospitals.