title: Surgery for Ulcerative Colitis Is Associated with a High Rate of Readmissions at 30 Days.
abstract: BACKGROUND
  Currently, the predictors of readmission after colectomy specifically for ulcerative colitis (UC) are poorly investigated. We sought to determine the rates and predictors of 30-day readmissions after colectomy for UC.
  
  
  METHODS
  Patients undergoing total proctocolectomy and end ileostomy, abdominal colectomy with end ileostomy, proctocolectomy with ileoanal pouch anastomosis (IPAA) formation and diverting ileostomy, one stage IPAA, or abdominal colectomy with ileorectal anastomosis at a tertiary care center between January 2002 and January 2012 for UC were included. Patients were identified using ICD-9 code 556.x. Each record was manually reviewed. The electronic record system was reviewed for demographic information, medical histories, UC history, medications, and data regarding the admission and discharge. Charts were reviewed for readmissions within 30 days of surgery. Univariate and multivariate analyses were performed using Stata v.13.
  
  
  RESULTS
  Two hundred nine patients with UC underwent a colectomy. Forty-three percent had a proctocolectomy with IPAA and diverting ileostomy and 32% had abdominal colectomy with end ileostomy. Seventy-six percent of surgeries were due to failure of medical therapy and 68% of patients were electively admitted for surgery. Thirty-two percent (n = 67/209) of the cohort was unexpectedly readmitted within 30 days. In multivariate model, proctocolectomy with IPAA and diverting ileostomy (odds ratio [OR] = 2.11; 95% CI, 1.06-4.19; P = 0.033) was the only significant predictor of readmission. Hospital length of stay >7 days (OR = 1.82; 95% CI, 0.98-3.41; P = 0.060), presence of limited UC (OR = 2.10; 95% CI, 0.93-4.74; P = 0.074), and steroid before admission (OR = 1.69; 95% CI, 0.90-3.2; P = 0.100) trended toward significance.
  
  
  CONCLUSIONS
  Surgery for UC is associated with a high rate of readmission. Further prospective studies are necessary to determine the means to reduce these readmissions.
authors.affiliation: *Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; †Department of Medicine, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts; ‡Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; §Gastroenterology Service, Dr. José Eleuterio González University Hospital, Monterrey, Mexico; ‖Department of Medicine and Division of Gastroenterology, University of Washington School of Medicine, University of Washington, Seattle, Washington; and ¶Department of Surgery and Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Feuerstein
authors.forename: Zhenghui G
authors.initials: ZG
authors.lastname: Jiang
authors.forename: Edward
authors.initials: E
authors.lastname: Belkin
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Lewandowski
authors.forename: Manuel
authors.initials: M
authors.lastname: Martinez-Vazquez
authors.forename: Anand
authors.initials: A
authors.lastname: Singla
authors.forename: Thomas
authors.initials: T
authors.lastname: Cataldo
authors.forename: Vitaliy
authors.initials: V
authors.lastname: Poylin
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D013256:Steroids