Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs.
BACKGROUND
After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements.


OBJECTIVE
The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.


METHODS
Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery.


METHODS
This study was conducted at an academic hospital and its affiliates.


METHODS
Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study.


METHODS
Readmission within 30 days of index discharge was the main outcome measured.


RESULTS
A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients.


CONCLUSIONS
Follow-up was limited to 30 days after initial discharge.


CONCLUSIONS
Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.
1Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 2Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 3Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts.
Rachelle N
RN
Damle
Nicole B
NB
Cherng
Julie M
JM
Flahive
Jennifer S
JS
Davids
Justin A
JA
Maykel
Paul R
PR
Sturrock
W Brian
WB
Sweeney
Karim
K
Alavi
D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007410:Intestinal Diseases / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012086:Reoperation / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology