title: Readmission rates and cost following colorectal surgery.
abstract: BACKGROUND
  Hospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions.
  
  
  OBJECTIVE
  We designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery.
  
  
  METHODS
  We reviewed commercial health insurance records of 10,882 patients who underwent colorectal surgery over a 7-year period (2002-2008).
  
  
  METHODS
  All patients undergoing colon and/or rectal resection ages 18 to 64 were included.
  
  
  METHODS
  The 30-day and 90-day readmission rates, the number of readmissions per patient, the median cost, length of stay, and risk factors for readmission were analyzed.
  
  
  RESULTS
  Thirty-day readmission occurred in 11.4% (1239/10,882) of patients. Readmission between 31 and 90 days occurred in an additional 11.9% (1027/10,882) of patients for a total 90-day readmission rate of 23.3%. Two or more readmissions occurred in 1.4% (155) and 5.2% (570) of patients in the first 30 and 90 days. Mean readmission length of stay was 8 days, and the median cost per stay was $8885. Initial hospitalization risk factors for readmission were the diagnosis of a surgical site infection (OR 1.2), creation of a stoma (OR 1.2), discharge to nursing home (OR 1.2), index admission length of stay >7 days (OR 1.2), proctectomy (OR 1.1), and severity of illness score (severity of illness 3 = OR 1.1; severity of illness 4 = OR 1.3).
  
  
  CONCLUSIONS
  Readmission after colorectal surgery occurs frequently and is associated with a cost of approximately $9000 per readmission. Nationwide these findings account for $300 million in readmission costs annually for colorectal surgery alone. Clinical and systems-based prevention strategies are needed to reduce readmission.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ewick1@jhmi.edu
authors: Elizabeth C
authors: EC
authors: Wick
authors: Andrew D
authors: AD
authors: Shore
authors: Kenzo
authors: K
authors: Hirose
authors: Andrew M
authors: AM
authors: Ibrahim
authors: Susan L
authors: SL
authors: Gearhart
authors: Jonathan
authors: J
authors: Efron
authors: Jonathan P
authors: JP
authors: Weiner
authors: Martin A
authors: MA
authors: Makary
mesh_terms: D000328:Adult; D003082:Colectomy / Q000191:economics / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D014481:United States; D055815:Young Adult