title: Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors.
abstract: BACKGROUND
  Data on readmission as well as the potential impact of length of stay (LOS) after colectomy for colon cancer remain poorly defined. The objective of the current study was to evaluate risk factors associated with readmission among a nationwide cohort of patients after colorectal surgery.
  
  
  METHODS
  We identified 149,622 unique individuals from the Surveillance, Epidemiology, and End Results-Medicare dataset with a diagnosis of primary colorectal cancer who underwent colectomy between 1986 and 2005. In-hospital morbidity, mortality, LOS, and 30-day readmission were examined using univariate and multivariate logistic regression models.
  
  
  RESULTS
  Primary surgical treatment consisted of right (37.4%), transverse (4.9%), left (10.5%), sigmoid (22.8%), abdominoperineal resection (7.3%), low anterior resection (5.6%), total colectomy (1.2%), or other/unspecified (10.3%). Mean patient age was 76.5 years and more patients were female (52.9%). The number of patients with multiple preoperative comorbidities increased over time (Charlson comorbidity score ≥3: 1986 to 1990, 52.5% vs 2001 to 2005, 63.1%; p < 0.001). Mean LOS was 11.7 days and morbidity and mortality were 36.5% and 4.2%, respectively. LOS decreased over time (1986 to 1990, 14.0 days; 1991 to 1995, 12.0 days; 1996 to 2000, 10.4 days; 2001 to 2005, 10.6 days; p < 0.001). In contrast, 30-day readmission rates increased (1986 to 1990, 10.2%; 1991 to 1995, 10.9%; 1996 to 2000, 12.4%; 2001 to 2005, 13.7%; p < 0.001). Factors associated with increased risk of readmission included LOS (odds ratio = 1.02), Charlson comorbidities ≥3 (odds ratio = 1.27), and postoperative complications (odds ratio = 1.17) (all p < 0.01).
  
  
  CONCLUSIONS
  Readmission rates after colectomies have increased during the past 2 decades and mean LOS after this operation has declined. More research is needed to understand the balance and possible trade off between these hospital performance measures for all surgical procedures.
authors.affiliation: Department of Surgery and Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: Jonathan
authors.initials: J
authors.lastname: Efron
authors.forename: John L
authors.initials: JL
authors.lastname: Cameron
authors.forename: Barish H
authors.initials: BH
authors.lastname: Edil
authors.forename: Richard D
authors.initials: RD
authors.lastname: Schulick
authors.forename: Michael A
authors.initials: MA
authors.lastname: Choti
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wolfgang
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000401:mortality / Q000592:standards; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology