title: Do hospital factors impact readmissions and mortality after colorectal resections at minority-serving hospitals?
abstract: Minority-serving hospitals have greater readmission rates after operative procedures including colectomy; however, little is known about the contribution of hospital factors to readmission risk and mortality in this setting. This study evaluated the impact of hospital factors on readmissions and inpatient mortality after colorectal resections at minority-serving hospitals in the context of patient- and procedure-related factors.
  
  
  
  More than 168,000 patients who underwent colorectal resections in 374 California hospitals (2004-2011) were analyzed using the State Inpatient Database and American Hospital Association Hospital Survey data. Sequential logistic regression analyses were performed to determine the associations between minority-serving hospital status and 30-day, 90-day, and repeated readmissions.
  
  
  
  Thirty-day, 90-day, and repeated readmission rates were 11.2%, 16.9%, and 2.9%, respectively. Odds for 30-day, 90-day, and repeated readmissions after colorectal resections were 19%, 20%, and 38% more likely at minority-serving hospitals versus non-minority-serving hospitals, respectively (P < .01), after controlling for age, sex, comorbidities, year, and procedure type. Patient factors accounted for up to 65% of the observed increase in odds for readmission at minority-serving hospitals while hospital-level factors contributed roughly 40%. Inpatient mortality was significantly greater at minority-serving hospitals versus non-minority-serving hospitals (4.9% vs 3.8%; P < .001). Risk factors significantly associated with readmissions and inpatient mortality included Medicaid/Medicare primary insurance, emergent operation, and ostomy creation. Low procedure volume was significantly associated with increased odds for inpatient mortality.
  
  
  
  Patient-level factors seemed to dominate the increased readmission risk after colorectal resections at minority-serving hospitals while hospital factors were less contributory. These findings need to be further validated to shape quality improvement interventions to decrease readmissions.
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hechenbleikner
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC; Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC.
authors.forename: Chaoyi
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lawrence
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Young
authors.initials: Y
authors.lastname: Hong
authors.affiliation: MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC.
authors.forename: Nawar M
authors.initials: NM
authors.lastname: Shara
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Lynt B
authors.initials: LB
authors.lastname: Johnson
authors.affiliation: Department of Surgery, MedStar Georgetown University Hospital, Washington, DC; MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; MedStar Health Research Institute, Washington, DC; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC. Electronic address: wba6@georgetown.edu.
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000208:ethnology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult