title: Predictors of readmission to non-index hospitals after colorectal surgery.
abstract: BACKGROUND
  Although a significant proportion of patients are readmitted to non-index hospitals after surgery, risk factors for non-index hospital readmission are not well defined.
  
  
  METHODS
  Using the California Office of State Health Planning and Development database from 2008 to 2012, patients readmitted to index versus non-index hospitals after colorectal surgery were directly compared. Risk factors for non-index hospital readmission were assessed through logistic regression.
  
  
  RESULTS
  Among the 14,401 patients requiring readmission, 10,890 (75.6%) were readmitted to index hospitals, whereas 3,511 (24.4%) were readmitted to non-index hospitals. Patients readmitted to non-index hospitals were more likely to be men and have a greater Charlson comorbidity index, non-private insurance, longer initial length of stay, longer travel distance, and non-home discharge disposition. On multivariable logistic regression analysis, living ≥10 miles from the index hospital was strongly predictive of non-index hospital readmission (odds ratio, 1.8; 95% confidence interval, 1.63 to 2.00).
  
  
  CONCLUSIONS
  Approximately 25% of readmissions after colorectal surgery will be to non-index hospitals. Risks factors include greater comorbidities, non-private health insurance, occurrence of an inpatient complication, longer length of stay, greater travel distance, and non-home discharge disposition.
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA. Electronic address: jmcloyd@mdanderson.org.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA.
authors.forename: Lyen
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA.
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Colectomy; Discharge; Geocoding; Hospital readmission; Outcomes; Travel distance