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Hospital readmissions are common after major surgery. Newly emerging international evidence shows that mortality and morbidity outcomes are worse for surgical patients who are readmitted to a different hospital, rather than to the index hospital where their surgery was done. 

These studies are limited but likely to be replicated and have a major international impact due to the generalisability and face validity of their results. The very limited available data indicate that rates of readmission to a non-index hospital (‘care fragmentation’) are markedly higher in Australia than in other countries, likely reflecting our public-private mix of hospital services and vast geography. 

We’ll use linked hospital admission, Medicare and mortality data for more than 10 million surgical procedures on around 4.5 million Australian patients to quantify and characterise care fragmentation following common surgical procedures. This includes cardiac, orthopaedic, thoracic, vascular, abdominal, colorectal, urological, neurosurgical and gynaecological interventions). We will evaluate the impact on outcomes in Australia and identify the factors that influence care fragmentation—including features of the index hospital, index admission, post-discharge care, patient and payer.  

Our findings will have important implications for Australian health policy, including identification of possible adverse impacts of centralisation of surgical services and of incentives to switch between private and public hospitals. 

We’ll work with health system stakeholders to synthesise these implications and identify potential policy responses, which might include a focus on coordination of care transitions and better clinical integration and data exchange among private and public sectors.