Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study.

Objective: To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery. Background: Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability. Methods: We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109). Results: Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2-7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30-1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24-1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61-2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24-3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33-1.95) were associated with readmission. Conclusions: Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.

Why men still get more promotions than women.

Though companies now invest heavily in mentoring and developing their best female talent, all that attention doesn't translate into promotions. A Catalyst survey of over 4000 high potentials shows that more women than men have mentors-yet women are paid $4600 less in their first post-MBA jobs, hold lower-level positions, and feel less career satisfaction. To better understand why, the authors conducted in-depth interviews with 40 participants in a mentoring program at a large multinational. All mentoring is not created equal, they discovered. Only sponsorship involves advocacy for advancement. The interviews and survey alike indicate that, compared with their male peers, high-potential women are overmentored, undersponsored, and not advancing in their organizations. Without sponsorship, women not only are less likely than men to be appointed to top roles but may also be more reluctant to go for them. Organizations such as Deutsche Bank, Unilever, Sodexo, and IBM Europe have established sponsorship programs to facilitate the promotion of high-potential women. Programs that get results clarify and communicate their goals, match sponsors and mentees on the basis of those goals, coordinate corporate and regional efforts, train sponsors, and hold those sponsors accountable.