title: Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions.
abstract: BACKGROUND
  The impact of developments in colorectal cancer surgery on length-of-stay (LOS) and re-admission have not been well described. In a population-based analysis, we investigated predictors of LOS and emergency readmission after the initial surgery episode.
  
  
  METHODS
  Incident colorectal cancers (ICD-O2: C18-C20), diagnosed 2002-2008, were identified from the National Cancer Registry Ireland, and linked to hospital in-patient episodes. For those who underwent colorectal resection, the associated hospital episode was identified. Factors predicting longer LOS (upper-quartile, > 24 days) for elective and emergency admissions separately, and whether LOS predicted emergency readmission within 28 days of discharge, were investigated using logistic regression.
  
  
  RESULTS
  8197 patients underwent resection, 63% (n = 5133) elective and 37% (n = 3063) emergency admissions. Median LOS was 14 days (inter-quartile range (IQR) = 11-20) for elective and 21 (15-33) for emergency admissions. For both emergency and elective admissions, likelihood of longer LOS was significantly higher in patients who were older, had co-morbidities and were unmarried; it was reduced for private patients. For emergency patients only the likelihood of longer LOS was lower for patients admitted to higher-volume hospitals. Longer LOS was associated with increased risk of emergency readmission.
  
  
  CONCLUSIONS
  One quarter of patients stay in hospital for at least 25 days following colorectal resection. Over one third of resected patients are emergency admissions and these have a significantly longer median LOS. Patient- and health service-related factors were associated with prolonged LOS. Longer LOS was associated with increased risk of emergency readmission. The cost implications of these findings are significant.
authors.affiliation: National Cancer Registry, Building 6800, Cork Airport Business Park, Cork, Ireland. m.kelly@ncri.ie
authors.forename: Maria
authors.initials: M
authors.lastname: Kelly
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
authors.forename: Fiona
authors.initials: F
authors.lastname: Dwane
authors.forename: Tracy
authors.initials: T
authors.lastname: Kelleher
authors.forename: Harry
authors.initials: H
authors.lastname: Comber
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011159:Population Surveillance; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000706:statistics & numerical data; D012042:Registries; D014850:Waiting Lists