title: Development and validation of a prediction model for patients discharged to post-acute care after colorectal cancer surgery.
abstract: As payment shifts toward bundled reimbursement, decreasing unnecessary inpatient care may provide cost savings. This study examines the association between discharge status, hospital duration of stay, and cost for colorectal operation patients without complications and uses risk factors to predict the need for post-acute care.
  
  
  
  We used the New York Statewide Planning and Research Cooperative System and the California Healthcare Cost and Utilization Project State Inpatient Databases to identify all patients who underwent operative resection for colorectal cancer in 2009-2010 and were discharged to home or post-acute care. Patients with complications were excluded. Duration of stay and inpatient costs were calculated. Risk factors associated with discharge to post-acute care were identified using multivariable logistic regression and were incorporated into a model to predict discharge status.
  
  
  
  A total of 5.4% of 23,942 patients were discharged to a post-acute care facility. Duration of sty was 2 days greater and $3,823 more costly for patients discharged to post-acute care. Significant risk factors included age, number of comorbidities, emergency admission, open operation, admission in the previous year, and a new ostomy. A scoring system using these factors accurately predicted discharge to post-acute care.
  
  
  
  Admissions after colorectal operations were greater and more costly for patients discharged to post-acute care even without operative complications. Risk factors can predict the need for post-acute care early in the postoperative course, thereby potentially facilitating early discharge planning.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: Elizabeth.Mollo@uphs.upenn.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bailey
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hoffman
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wirtalla
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Karakousis
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000191:economics / Q000639:trends*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D019467:Subacute Care / Q000191:economics / Q000379:methods*; D014481:United States