Risk factors associated with 30-day postoperative readmissions in major gastrointestinal resections.
OBJECTIVE
Preventable readmissions represent a major burden on the health care system and risk stratification of patients can help direct costly resources. This study examines patient characteristics, surgical factors, and postoperative complications associated with 30-day postoperative readmissions in gastrointestinal (GI) resections.


METHODS
Inpatients undergoing major GI surgery were selected from the 2011 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Resections were classified into foregut, small bowel, colorectal, liver, and pancreatic using Current Procedural Terminology (CPT) codes. Postoperative complications were divided into pre- and post-discharge groups using time to complication and discharge. Univariate analysis compared patient and surgical characteristics and pre-discharge complications with 30-day unplanned readmission rates. Factors with a p value <0.1 were included in multivariate logistic regression. A p value <0.05 was considered statistically significant.


RESULTS
For 42,609 patients undergoing GI resection, the overall 30-day unplanned readmission rate was 12.3 % ranging from 11.8 % for colorectal resections to 16.3 % for pancreatic resections. Major predictors of 30-day readmissions included pre-discharge major complications (odds ratio [OR] = 1.28, 95 % confidence interval [CI] 1.18-1.39, p < 0.0001), chronic steroid use (OR = 1.67, 95 % CI 1.50-1.86, p < 0.0001), operative time ≥4 h (OR = 1.45, 95 % CI 1.35-1.56, p < 0.0001) and discharge to a facility other than home (OR = 1.37, 95 % CI 1.23-1.50, p < 0.0001).


CONCLUSIONS
Unplanned 30-day readmissions represent a major clinical and financial concern, but some may be foreseeable and potentially modifiable. This model provides insight into factors that could inform resource utilization and postoperative care to help prevent readmissions in select GI surgical patients.
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY, 14642, USA, Kristin_Kelly@URMC.rochester.edu.
Kristin N
KN
Kelly
James C
JC
Iannuzzi
Aaron S
AS
Rickles
John R T
JR
Monson
Fergal J
FJ
Fleming
D000368:Aged; D001803:Blood Transfusion; D003082:Colectomy / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012007:Rectum / Q000601:surgery; D012140:Respiratory Tract Diseases / Q000209:etiology; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
D013256:Steroids