Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients.
BACKGROUND
To evaluate readmissions to determine predictors and patterns of readmission.


METHODS
Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined.


RESULTS
A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older (P = .003), had more comorbidities (P < .0001), longer operative times (P < .0001), length of stay (P < .0001), and higher costs (P = .002). At the time of discharge, more readmitted patients required temporary nursing (P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time (P = .05) and LOS were longer (P = .028), and more patients required temporary nursing care at the time of discharge (P = .046). Readmissions caused an additional mean hospital cost of $12,670.89.


CONCLUSIONS
Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Deborah S
DS
Keller
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Brian
B
Swendseid
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Zhamak
Z
Khorgami
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Bradley J
BJ
Champagne
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Harry L
HL
Reynolds
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
Sharon L
SL
Stein
Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address: Conor.Delaney@uhhospitals.org.
Conor P
CP
Delaney
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D003106:Colon / Q000601:surgery; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012002:Rectal Diseases / Q000453:epidemiology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies
Colorectal surgery; Enhanced recovery pathways; Healthcare outcomes; Healthcare utilization; Readmissions