title: Early discharge and hospital readmission after colectomy for cancer.
abstract: BACKGROUND
  Early discharge after colectomy has been shown to be feasible in studies from specialty centers, but we hypothesized that benefits of early discharge might be offset by higher risk of readmission in the surgical community as a whole. Minimizing readmissions is a national health policy priority.
  
  
  OBJECTIVE
  This study aimed to determine whether hospitals discharging patients early had increased readmission rates.
  
  
  METHODS
  Patients undergoing colectomy surgery for cancer were studied using national Medicare data (MEDPAR database). Multiple logistic regression was performed to determine whether hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) had increased readmission rates. Results were adjusted for patient comorbidity, emergency operation, laparoscopic surgery, demographic factors, and complications. A separate analysis at the patient level was conducted to determine risk factors for readmission.
  
  
  METHODS
  Early discharge rates at US acute care hospitals were investigated.
  
  
  METHODS
  Patients 65 and older undergoing colectomy surgery for cancer (2003-2008, n = 477,461) were included.
  
  
  METHODS
  The main outcome measure was 30-day, all hospital readmission rates.
  
  
  RESULTS
  Hospitals with a pattern of early discharge (median length of stay ≤ 5 d) were not found to have a higher risk-adjusted readmission rate than hospitals with the usual median length of stay (16.3% vs 15.7%, P = .077). However, changing the cutoff for "early discharge" to ≤ 4 days revealed an increased risk for readmission among "very early discharge" hospitals (risk-adjusted readmission rate 21.3% vs 15.7%, P < .001). At the patient level, independent risk factors for readmission included older age, male sex, black race, lower socioeconomic status, urgent/emergent surgery, comorbidities, complications, open (vs laparoscopic) surgery, and longer length of stay for the index hospitalization.
  
  
  CONCLUSIONS
  Limitations of this study included the limitations of the administrative data and elderly population.
  
  
  CONCLUSIONS
  Hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) do not have a higher risk-adjusted readmission rate than other hospitals. These results support the safety of early discharge programs in the Medicare population.
authors: Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. hendren@med.umich.edu
authors: Samantha
authors: S
authors: Hendren
authors: Arden M
authors: AM
authors: Morris
authors: Wenying
authors: W
authors: Zhang
authors: Justin
authors: J
authors: Dimick
mesh_terms: D000368:Aged; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States