Hospital readmissions after colectomy: a population-based study.
BACKGROUND
Surgical readmissions will be targeted for reimbursement cuts in the near future. We sought to understand differences between hospitals with high and low readmission rates in a statewide surgical collaborative to identify potential quality improvement targets.


METHODS
We studied 5,181 patients undergoing laparoscopic or open colectomy at 24 hospitals participating in the Michigan Surgical Quality Collaborative between May 2007 and January 2011. We first calculated hospital risk-adjusted 30-day readmission rates. We then compared reasons for readmission, risk-adjusted complication rates, risk-adjusted inpatient length of stay, and composite process compliance across readmission rate quartiles.


RESULTS
Hospitals with the lowest 30-day readmission rates averaged 5.1%, compared with 10.3% in hospitals with the highest rates (p < 0.01). Despite wide variability in readmission rates, reasons for readmission were similar between hospitals. Compared with hospitals with low readmission rates, hospitals with high readmission rates had higher risk-adjusted complication rates (29% vs 22%, p = 0.03), but similar median lengths of stay (5.5 days vs 5.6 days, p = 0.61). Although measures to reduce complications were associated with lower surgical site infection rates, they were not associated with reduced overall complication or readmission rates. There was wide variation in complication rates among hospitals with similar readmission rates.


CONCLUSIONS
There is wide variation in hospital readmission rates after colectomy that correlates with overall complication rates. However, the wide variation in complication rates among hospitals with similar readmission rates suggests that hospital complication rates explain little about their readmission rates. Preventing readmissions after colectomy in hospitals with high readmission rates will require more attention to different care processes currently unmeasured in many clinical registries as well as complication prevention.
Department of Surgery, University of Michigan Health System, Ann Arbor, MI. Electronic address: rkrell@med.umich.edu.
Robert W
RW
Krell
Micah E
ME
Girotti
Danielle
D
Fritze
Darrell A
DA
Campbell
Samantha
S
Hendren
D000368:Aged; D003082:Colectomy / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D012042:Registries; D012189:Retrospective Studies; D020379:Risk Adjustment