Hospital readmissions and emergency department visits following laparoscopic and open colon resection for cancer.
BACKGROUND
Laparoscopic colectomy for the treatment of colon cancer has been widely adopted in community practice, in part, because of shorter hospitalizations. The benefits of a shorter hospital stay are only realized if readmissions and emergency department visits, collectively termed revisits, do not increase after discharge. We conducted a population-based analysis to determine whether hospitals with higher laparoscopic colectomy rates have higher revisit rates.


OBJECTIVE
The aim of this study was to determine whether hospital utilization after discharge is increased for patients undergoing laparoscopic colectomy for cancer.


METHODS
This is a retrospective cohort study.


METHODS
Data were gathered from the Healthcare Cost and Utilization Project's inpatient and emergency department databases for California. These databases include data from all nonfederal hospitals in the State of California.


METHODS
Patients who underwent elective colectomy for cancer from 2008 to 2009 were included.


METHODS
The primary intervention was elective colectomy with the use of the open or laparoscopic approach.


METHODS
The correlation between hospital laparoscopy rates and hospital readmission rates, emergency department visit rates, and revisit rates was calculated.


RESULTS
Overall, 6760 patients were treated at 176 hospitals. For every 100 patients discharged, there were 14.0 readmissions and 9.2 emergency department encounters. At the hospital level, laparoscopy rates varied considerably (median = 45.7%, range = 2.2%-88.9%), as did the risk-standardized readmission (12.1%, 8.6%-16.5%), emergency department encounter (7.8%, 4.1%-18.0%), and revisit rates (17.9%, 13.0%-26.4%). A hospital's laparoscopy rate was not significantly correlated with its risk-standardized readmission (weighted correlation coefficient = 0.05, p = 0.50), emergency department encounter (-0.11, p = 0.16), or revisit (-0.03, p = 0.70) rates.


CONCLUSIONS
There are inherent limitations when using administrative data.


CONCLUSIONS
Hospitals where a greater proportion of colon resections for cancer are approached laparoscopically do not have higher 30-day, risk-standardized readmission, emergency department encounter, or revisit rates.
Department of Surgery, Wright Patterson Air Force Base, Dayton, OH, USA. dallas.hansen@gmail.com
Dallas G
DG
Hansen
Justin P
JP
Fox
Cary P
CP
Gross
John S
JS
Bruun
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult