title: The appropriate measurement of postdischarge readmissions in Medicare colon surgery.
abstract: BACKGROUND
  Readmissions after inpatient care are being used as a metric for clinical outcomes for surgeons and hospitals, but without standardization of the appropriate postdischarge period.
  
  
  METHODS
  Elective colon surgery (ECS) for Medicare patients was reviewed to define the frequency and causes of readmission at 30, 60, and 90 days after discharge. Elective, trauma, and cancer readmissions were excluded. A prediction model at 90 days after discharge was designed to identify risk factors that were associated with readmissions.
  
  
  RESULTS
  A total of 107,459 live discharges after ECS had 12,746 readmissions at 30 days, 4,601 1st-time readmissions at 31 to 60 days, and another 4,042 1st-time readmissions from days 61 to 90; 40% of initial and nearly 50% of all readmissions occurred from days 31 to 90. Primary causes for readmission were gastrointestinal, infectious, and cardiopulmonary events.
  
  
  CONCLUSIONS
  The 90-day postdischarge time period provides the most accurate measurement interval for relevant readmissions after ECS.
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA. Electronic address: dfry@consultmpa.com.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA; Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Nedza
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Locke
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA.
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Reband
authors.affiliation: MPA Healthcare Solutions, Clinical Outcomes Management, 1 East Wacker Drive, #1210, Chicago, IL 60601, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Pine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000601:surgery*; D003953:Diagnosis-Related Groups; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Colon surgery; Postoperative infections; Prolonged length of stay; Readmissions; Risk adjustment