title: Patient and Provider-Identified Factors Contributing to Surgical Readmission After Colorectal Surgery.
abstract: OBJECTIVE
  Nearly one in seven surgical patients is readmitted to the hospital within 30 days of discharge. Few studies have identified patient-centric factors that raise the risk of both preventable and nonpreventable postoperative readmissions.
  
  
  METHODS
  Over 6 months in 2012, 48 colorectal surgical patients were identified on re-admission within 30 days of discharge. We prospectively obtained information on the patient's and primary surgeon's views on factors that contributed to readmission, and compiled data to produce an external list of contributing factors. A standard cost analysis was performed.
  
  
  RESULTS
  48 colorectal surgery patients participated, and 47 were included in this patient-centric evaluation of factors leading to readmission. The three primary readmission diagnoses included dehydration, fever, and ileus or small bowel obstruction. Of all readmissions, 23% were considered to be preventable. 38% of patients had scheduled follow-up appointments that were documented in the medical record at the time of discharge. Providers identified several factors contributing to readmission including difficulty understanding discharge plan, medication management and premature discharge. Per patient, the cost of preventable readmission was $15,366 (±20%; $12,293-$18,439). Total preventable cost was $169,025 (±20%; $135,220-$202,829).
  
  
  CONCLUSIONS
  The ability to obtain an outpatient postoperative appointment and the understanding of their own postoperative care were the most commonly identified barriers. Interventions to help reduce unnecessary readmissions include a standard discharge process and coordinator, and routine (<7 days) postdischarge outpatient appointments. Successful reduction of preventable readmissions would result in approximately $3.6 million in cost savings per 1,000 colorectal readmissions.
authors.affiliation: a Department of Anesthesia, Critical Care, and Pain Medicine , Beth Israel Deaconess Medical Center, Critical Care and Pain Medicine.
authors.forename: Tori
authors.initials: T
authors.lastname: Sutherland
authors.affiliation: b Department of Quality and Safety , Brigham and Women's Hospital.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: David-Kasdan
authors.affiliation: b Department of Quality and Safety , Brigham and Women's Hospital.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beloff
authors.affiliation: a Department of Anesthesia, Critical Care, and Pain Medicine , Beth Israel Deaconess Medical Center, Critical Care and Pain Medicine.
authors.forename: Ariel
authors.initials: A
authors.lastname: Mueller
authors.affiliation: c Department of Surgery , Brigham and Women's Hospital.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Whang
authors.affiliation: c Department of Surgery , Brigham and Women's Hospital.
authors.forename: Ronald
authors.initials: R
authors.lastname: Bleday
authors.affiliation: d Department of Anesthesiology , Perioperative and Pain Medicine, Brigham and Women's Hospital.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D003107:Colorectal Surgery / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D003681:Dehydration / Q000209:etiology / Q000628:therapy; D005334:Fever / Q000209:etiology / Q000628:therapy; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D066231:Surgeons; D013997:Time Factors
keywords: colorectal surgery; complication; patient-centric analysis; postoperative; readmission; reasons