title: Outcomes and prediction of hospital readmission after intestinal surgery.
abstract: BACKGROUND
  Clinical care pathways reduce postoperative stay after major bowel operations. Concerns about unexpected early readmissions and delays in diagnosis of complications remain unanswered. The objectives of this study were determination of readmission rate and outcomes for patients undergoing intestinal operations.
  
  
  METHODS
  Patients readmitted (PR) within 30 days of discharge after intestinal operations were compared with patients who were not readmitted (NR). Variables that might predict readmission were evaluated.
  
  
  RESULTS
  Of 553 patients, 56 (10.1%) were readmitted after 10 days (interquartile range [IQR] 4.5 to 15.5 days). PR and NR groups had similar age, gender, diagnosis, preoperative comorbidities, and index operations. Discharge hemoglobin level, white cell count, antibiotic use, or presence of stoma did not affect readmission. PR had a greater frequency of steroid use (p = 0.03) during index admission. Median length of stay for the index hospitalization was 5 days (IQR 4 to 8 days) for the NR and 6 days (IQR 4.8 to 9 days) for the PR group (p = 0.049). Duration of readmission was 4 days (IQR 2 to 9 days) in the PR group, with equal total median length of stay identical for PR and NR patients with complications (median 12 days). Clinical outcomes for PR patients and NR patients with complications were similar.
  
  
  CONCLUSIONS
  Early readmission is an unpredictable sequel of major bowel operations; it does not correlate with shorter hospital stay. Identification of unpredictable complications after discharge that require later invasive intervention does not adversely affect clinical outcomes. Readmission within 30 days of a patient who has attained standardized discharge criteria may not be a valid indicator of poor quality of care.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Malcolm
authors.initials: M
authors.lastname: Steel
authors.forename: Thomas
authors.initials: T
authors.lastname: Garafalo
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
mesh_terms: D016022:Case-Control Studies; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors