title: A multicentre study to determine the incidence, demographics, aetiology and outcomes of 6-day emergency readmission following day-case endoscopy.
abstract: BACKGROUND
  Emergency readmission after elective procedures is a quality indicator of healthcare delivery, but data for endoscopy are limited.
  
  
  OBJECTIVE
  Using hospital episode statistics (HES) registration systems and a multicentre audit to describe outcomes of emergency readmission following elective endoscopy.
  
  
  METHODS
  Emergency readmissions (April 2008-2009) within 6 days of an elective day-case upper-GI endoscopy (UE) and lower GI endoscopy (LE) were subjected to a multicentre retrospective audit (north-west of England) following the identification of cases from routinely coded hospital administrative data from HES.
  
  
  RESULTS
  Of 29 868 day cases, there were 235 readmissions, of which 147 (63%) were endoscopy related. The overall endoscopy readmission rate was 0.5% and the highest for therapeutic UE (1.74%; P=0.0001). The rates for therapeutic LE, diagnostic UE and LE were 0.6, 0.5 and 0.4%, respectively. The incidence of readmission was 0.2% because of cardiorespiratory event, 0.14% for symptoms and 0.08, 0.03, 0.02 and 0.016%, respectively, for bleeding, perforation, obstruction and nonrespiratory sepsis. Management was simple observation in 84.4%, intravenous antibiotics in 7.5%, surgery in 4.8% and repeat endoscopy in 2.7%. Although 24.5% were short-stay discharges, the mean hospital stay was 8.2 days. All-cause 30-day mortality was low at 0.06%, but was considerably higher in readmitted patients at 6.8% (P=0.0001).
  
  
  CONCLUSIONS
  Novel insights into readmission rates can be gained following endoscopy using a combination of commercial analytical tools to examine HES data to identify eligible readmitted cases; multicentred patient-level audit readmission rates varied predictably across procedure types with cardiorespiratory events, the major cause. The risk of mortality in readmitted patients was significant.
authors.affiliation: Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK. sanchoy@aol.com
authors.forename: Sanchoy
authors.initials: S
authors.lastname: Sarkar
authors.forename: Joe
authors.initials: J
authors.lastname: Geraghty
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Moore
authors.forename: Simon
authors.initials: S
authors.lastname: Lal
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.forename: Keith
authors.initials: K
authors.lastname: Bodger
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000009:adverse effects; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012812:Sigmoidoscopy / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents