title: Variation in readmission by hospital after colorectal cancer surgery.
abstract: OBJECTIVE
  Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. Readmission has become a major hospital quality metric, but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment.
  
  
  OBJECTIVE
  To assess the variability in risk-adjusted readmission rates among hospitals after colorectal surgery.
  
  
  METHODS
  We performed a hierarchical multivariable logistic regression analysis of observational data obtained from the Surveillance, Epidemiology, and End Results-Medicare linked database, a nationally representative cancer registry. We studied 44,822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002.
  
  
  METHODS
  Variation in risk-adjusted 30-day readmission among hospitals.
  
  
  RESULTS
  The median age of the study patients was 78 years (interquartile range [IQR], 72-83 years). The overall 30-day readmission rate was 12.3% (n = 5502). Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals, with a range of 11.3% to 13.2% (IQR, 12.1%-12.4%). Furthermore, the 95% CI for hospital-specific readmission overlapped the overall mean at every hospital.
  
  
  CONCLUSIONS
  Little risk-adjusted variation exists in hospital readmission rates after colorectal surgery. The use of readmission rates as a high-stakes quality measure for payment adjustment or public reporting across surgical specialties should proceed cautiously and must include appropriate risk adjustment.
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Lucas
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Bischof
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology