The grass may not always be greener on the other side when it comes to post-surgery care, according to a new study published in The Lancet today.

The study found that patients who needed to be readmitted for further treatment after a major surgical procedure fared significantly better when they returned to the hospital where they received the original operation as opposed to when they traveled elsewhere. These findings may somewhat complicate the picture surrounding the burgeoning market for so-called medical tourism.

The authors analyzed the Medicare records of 9,440,503 patients who had undergone one of twelve surgical procedures across five different medical specialities from 2001 to 2011. Keying on those who were readmitted to a hospital no more than 30 days after the original procedure, they then tried to determine whether care at the original, or index, hospital predicted better rates of mortality 90 days after readmission when compared to care at a non-index hospital (About 66 to 83 percent of patients returned to the index hospital, depending on the surgery).

"For all types of surgery, unadjusted 90 day mortality was significantly lower for patients who were readmitted to the index hospital where surgery occurred than for patients readmitted to other hospitals," they concluded. "Furthermore, patients who needed management for a surgical complication at the time of readmission had a significant reduction in 90 day mortality in all comparisons if the same surgeon was involved in both the index and readmission treatment."

Their findings held true under different types of statistical analysis, and for those who were readmitted because of either medical or surgical complications, though especially for the latter scenario. "In our inverse probability weighted analysis, readmission to the index hospital was associated with a 26% reduction in risk of 90 day mortality compared with readmission to non-index hospitals," they wrote.

The greatest protective effect was seen among those who had all or part of their pancreas removed (pancreatectomy), bypass surgery to restore blood flow to the legs (aortobifemoral bypass), and who had their earlier surgery-induced hernias repaired (ventral hernia repair).

Noting that hospital readmission is a major risk factor for early death, the authors are adamant about the importance of their findings, which is likely the largest exploration of its kind. "This is not a small issue. Between 5 to 22 percent of patients were readmitted in our study, depending on the type of surgery," says lead author Dr. Benjamin Brooke, an assistant professor of surgery at the University of Utah School of Medicine in a press statement. "Our work suggests that striving to maintain continuity of care in the same hospital, and by the same medical team when possible, is critical to achieve the best outcomes should complications arise after surgery."

And the study particularly has broader implications for the growing trend to outsource complicated surgeries to top-of-the-line medical centers located far from the patient’s home, despite the fact that the authors were only able to examine Medicare patients, who are obviously older.

"Patients increasingly travel long distances to have their operations done at hospitals that are recognised as providing high-quality care or because of a financial incentive for health insurers," the authors wrote. "When patients need readmission for complications, the assumption is that patients can seek care at local hospitals without a significant penalty in surgical outcomes. Our results challenge this theory, and we argue that continuity of surgical care needs to be treated as a competing metric of quality in choices of hospital in which to undergo major surgery."

Source: Brooke B, Finlayson S, Kraiss L, et al. Readmission destination and risk of mortality after major surgery: an observational cohort study. The Lancet. 2015