Importance Postoperative readmission data are used to measure hospital performance, yet the extent to which these readmissions reflect surgical quality is unknown.

Objective To establish expert consensus on whether reasons for postoperative readmission are associated with the quality of surgery in the index admission.

Design, Setting, and Participants In a modified Delphi process, a panel of 14 experts in medical and surgical readmissions comprising physicians and nonphysicians from Veterans Affairs (VA) and private-sector institutions reviewed 30-day postoperative readmissions from fiscal years 2008 through 2014 associated with inpatient surgical procedures performed at a VA medical center between October 1, 2007, and September 30, 2014. The consensus process was conducted from January through May 2017. Reasons for readmission were grouped into categories based on International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Panelists were given the proportion of readmissions coded by each reason and median (interquartile range) days to readmission. They answered the question, “Does the readmission reason reflect possible surgical quality of care problems in the index admission?” on a scale of 1 (never related) to 5 (directly related) in 3 rounds of consensus building. The consensus process was completed in May 2017 and data were analyzed in June 2017.

Main Outcomes and Measures Consensus on proportion of ICD-9–coded readmission reasons that reflected quality of surgical procedure.

Results In 3 Delphi rounds, the 14 panelists achieved consensus on 50 reasons for readmission; 12 panelists also completed group telephone calls between rounds 1 and 2. Readmissions with diagnoses of infection, sepsis, pneumonia, hemorrhage/hematoma, anemia, ostomy complications, acute renal failure, fluid/electrolyte disorders, or venous thromboembolism were considered associated with surgical quality and accounted for 25 521 of 39 664 readmissions (64% of readmissions; 7.5% of 340 858 index surgical procedures). The proportion of readmissions considered to be not associated with surgical quality varied by procedure, ranging from to 21% (613 of 2331) of readmissions after lower-extremity amputations to 47% (745 of 1598) of readmissions after cholecystectomy.

Conclusions and Relevance One-third of postoperative readmissions are unlikely to reflect problems with surgical quality. Future studies should test whether restricting readmissions to those with specific ICD-9 codes might yield a more useful quality measure.

重要性 术后再入院的数据用于衡量医院的表现，但这些再入院反映手术质量的程度尚不清楚。

目的 建立关于患者再次入院的原因是否与指数入院的手术质量相关的专家共识。

设计，设置和参与者 在经过改进的Delphi流程中，由14名退伍军人事务管理局（VA）和私营机构的内科和非内科医师组成的医学和外科再入院专家小组审查了从2008财年到2014财年的30天术后再入院率。于2007年10月1日至2014年9月30日在VA医疗中心进行了住院外科手术。共识过程于2017年1月至2017年5月进行。再次入院的原因根据《国际疾病分类》第九版（ICD-9）诊断代码。给予小组成员按每个原因编码的再入院率和再入院的中位数（四分位间距）天数。他们回答了一个问题：“重新入院的原因是否反映了入院时可能出现的外科护理质量问题？” 在三轮共识建立过程中以1（从不相关）到5（直接相关）的比例进行评估。共识过程已于2017年5月完成，数据已于2017年6月进行了分析。

主要结果与措施 关于ICD-9编码再入院比例的共识，反映了手术程序的质量。

结果 在3个Delphi回合中，14位小组成员在50个再次入学的原因上达成了共识；12名小组成员还完成了第1轮和第2轮之间的小组电话通话。再次入院可诊断出感染，败血症，肺炎，出血/血肿，贫血，造口并发症，急性肾衰竭，体液/电解质紊乱或静脉血栓栓塞，被认为与手术质量有关在39 664例再入院病例中占25 521例（占再入院率的64％；在340 858指数外科手术中占7.5％）。被认为与手术质量无关的再入院率因手术而异，范围从下肢截肢后再入院的21％（2331的613）到胆囊切除术后再入院的47％（1598的745）有所不同。

结论和相关性 术后再入院的三分之一不太可能反映出手术质量问题。未来的研究应该测试将再入学限制为使用特定ICD-9编码的人是否可以产生更有用的质量度量。