title: Readmissions After Colectomy: The Upstate New York Surgical Quality Initiative Experience.
abstract: BACKGROUND
  Hospital readmissions remain a major medical and financial concern to the healthcare system and have become an area of interest in health outcomes performance metrics. There is a pressing need to identify process measures that may help reduce readmissions.
  
  
  OBJECTIVE
  Our aim was to assess the patient characteristics and surgical factors associated with 30-day readmissions for colorectal surgery in Upstate New York.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The study included colectomy cases abstracted for the National Surgical Quality Improvement Program in the Upstate New York Surgical Quality Initiative from June 2013 to June 2014.
  
  
  METHODS
  The study consists of 630 colectomies. Patients with a length of stay >30 days or who died during the index admission were excluded.
  
  
  METHODS
  Readmission within 30 days of surgery was the main outcome measure.
  
  
  RESULTS
  Of 630 colectomy patients, 76 patients (12%) were readmitted within 30 days of surgery. Major and minor complications were associated with 30-day postoperative readmission (OR = 2.99 (95% CI, 1.70-5.28) and OR = 2.19 (95% CI, 1.09-4.43)) but excluded from final analysis because they included both predischarge and postdischarge complications. Risk factors independently associated with 30-day postoperative readmission included diabetes mellitus (OR = 1.94 (95% CI, 1.02-3.67)), smoker within the past year (OR = 2.01 (95% CI, 1.12-3.60)), no scheduled follow-up (OR = 2.20 (95% CI, 1.25-3.86)), and ileostomy formation (OR = 1.97 (95% CI, 1.03-3.77)).
  
  
  CONCLUSIONS
  Limitations include the retrospective design and only 30 days of postoperative follow-up.
  
  
  CONCLUSIONS
  Consistent with national trends, 1 in 8 patients in the Upstate New York Surgical Quality Initiative program was readmitted within 30 days after colorectal surgery. This study identified several risk factors that may act as tangible targets for intervention, including preoperative smoking cessation programs, optimization of diabetic management, mandatory scheduled follow-up appointments on discharge, and ostomy care pathways.
authors.affiliation: 1 Department of Surgery, Surgical Health Outcomes and Research Enterprise, University of Rochester Medical Center, Rochester, New York 2 Department of Surgery, State University of New York, Upstate Medical University, Syracuse, New York 3 Department of Surgery, Basset Healthcare, Cooperstown, New York.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hensley
authors.forename: Robert N
authors.initials: RN
authors.lastname: Cooney
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hellenthal
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: John R
authors.initials: JR
authors.lastname: Monson
authors.forename: Kristin N
authors.initials: KN
authors.lastname: Kelly
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000379:methods / Q000592:standards*; D011183:Postoperative Complications / Q000209:etiology; D058996:Quality Improvement; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult