title: Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival?
abstract: OBJECTIVE
  Hospital readmission is undesirable for patients and care providers as this can affect short-term recovery and carries financial consequences. It is unknown if readmission has long-term implications. We aimed to investigate the impact of 30-day readmission on long-term overall survival (OS) following colorectal cancer resection within enhanced recovery after surgery (ERAS) care and explore the reasons for and the severity and details of readmission episodes.
  
  
  METHODS
  A dedicated, prospectively populated database was reviewed. All patients were managed within an established ERAS programme. Five-year OS was calculated using the Kaplan-Meier method. The number, reason for and severity of 30-day readmissions were classified according to the Clavien-Dindo (CD) system, along with total (initial and readmission) length of stay (LoS). Multivariate analysis was used to identify factors predicting readmission.
  
  
  RESULTS
  A total of 1023 consecutive patients underwent colorectal cancer resection between 2002 and 2015. Of these, 166 (16%) were readmitted. Readmission alone did not have a significant impact on 5-year OS (59% vs 70%, P = 0.092), but OS was worse in patients with longer total LoS (20 vs 14 days, P = 0.04). Of the readmissions, 121 (73%) were minor (CD I-II) and 27 (16%) required an intervention of which 16 (10%) were returned to theatre. Gut dysfunction 32 (19%) and wound complications 23 (14%) were the most frequent reasons for readmission. Prolonged initial LoS, rectal cancer and younger age predicted for hospital readmission.
  
  
  CONCLUSIONS
  Readmission does not have a significant impact on 5-year OS. A broad range of conditions led to readmission, with the majority representing minor complications.
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Curtis
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: E
authors.initials: E
authors.lastname: Noble
authors.affiliation: Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
authors.forename: E
authors.initials: E
authors.lastname: Salib
authors.affiliation: Information Management Team, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hipkiss
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: E
authors.initials: E
authors.lastname: Meachim
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: R
authors.initials: R
authors.lastname: Dalton
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: A
authors.initials: A
authors.lastname: Allison
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ockrim
authors.affiliation: Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.|Faculty of Science, University of Bath, Bath, UK.
authors.forename: N K
authors.initials: NK
authors.lastname: Francis
mesh_terms: D000367:Age Factors; D000368:Aged; D003082:Colectomy / Q000401:mortality* / Q000534:rehabilitation; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011182:Postoperative Care / Q000379:methods / Q000401:mortality*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D012086:Reoperation / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Readmission; colorectal cancer; enhanced recovery; outcome; reattendance