title: Early discharge and readmission after colorectal resection.
abstract: BACKGROUND
  Emphasis on the provision of high quality, cost-effective healthcare has meant increasing efforts at reducing postoperative length of stay while reducing 30-d readmission rates. The aim of this study was to identify factors associated with early discharge (ED) and to evaluate the effectof ED on readmission after colorectal resection.
  
  
  METHODS
  We identified all inpatients aged ≥18 y who underwent a colorectal resection in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, 2011. ED was defined as a length of stay ≤25th percentile by procedure (rectal resection, open colectomy, and laparoscopic colectomy). Multivariate logistic regression was used to identify factors significantly associated with ED and readmission. A subset analysis was performed by procedure type.
  
  
  RESULTS
  Of 28,532 patients, 2171 (7%) underwent rectal resection, 14,976 (52%) underwent open colectomy, and 11,385 (40%) underwent laparoscopic colectomy with an ED on or before postoperative days 5, 5, and 3, respectively. The overall cohort included patients with a mean age of 61 y. A total of 52% were women and 37% were colorectal cancer patients. Age >65 y, recent steroid use, simultaneous ostomy creation, nonelective surgery, need for reoperation, and a postoperative occurrence before discharge were significantly associated with a reduced likelihood of ED. The overall rate of readmission was 12%. Patients who were discharged early were significantly less likely to be readmitted (odds ratio, 0.77; 95% confidence interval, 0.70-0.84).
  
  
  CONCLUSIONS
  In the appropriate patient population, ED after colorectal surgery may be implemented without any adverse effect on readmission rates.
authors.affiliation: Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: rgaugler@gmail.com.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hoffman
authors.affiliation: Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California.
authors.forename: Clifford
authors.initials: C
authors.lastname: Ko
authors.affiliation: Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Najjia
authors.initials: N
authors.lastname: Mahmoud
authors.affiliation: Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.affiliation: Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: ACS NSQIP; Colon; Colorectal; Early discharge; Laparoscopic; Readmission; Surgery