In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study.
BACKGROUND
The simultaneous assessment of multiple indicators for quality of care is essential for comparisons of performance between hospitals and health care systems. The aim of this study was to assess the rates of in-hospital mortality and 30-day readmission and length of hospital stay (LOS) in patients who underwent surgical procedures for colorectal cancer between 2005 and 2014 in Italy.


METHODS
All patients in the National Italian Hospital Discharge Dataset who underwent a surgical procedure for colorectal cancer during the study period were included. The adjusted odd ratios for risk factors for in-hospital mortality, 30-day readmission, and LOS were calculated using multilevel multivariable logistic regression.


RESULTS
Among the 353 941 patients, rates of in-hospital mortality and 30-day readmission were 2.5% and 6%, respectively, and the median LOS was 13 days. High comorbidity, emergent/urgent admission, male gender, creation of a stoma, and an open approach increased the risks of all the outcomes at multivariable analysis. Age, hospital volume, hospital geographic location, and discharge to home/non-home produced different effects depending on the outcome considered. The most frequent causes of readmission were infection (19%) and bowel obstruction (14.6%).


CONCLUSIONS
We assessed national averages for mortality, LOS and readmission and related trends over a 10-year time. Laparoscopic surgery was the only one that could be modified by improving surgical education. Higher hospital volume was associated with a LOS reduction, but our findings only partially support a policy of centralization for colorectal cancer procedures. Surgical site infection was identified as the most preventable cause of readmission.
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy. Electronic address: puc@unipd.it.
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S
Pucciarelli
Veneto Tumour Registry, Veneto Region, Padova, Italy.
M
M
Zorzi
Epidemiological Service of the Veneto Region, Padova, Italy.
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N
Gennaro
Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
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G
Gagliardi
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
A
A
Restivo
Epidemiological Service of the Veneto Region, Padova, Italy.
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M
Saugo
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
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A
Barina
Veneto Tumour Registry, Veneto Region, Padova, Italy; Department of Medicine DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy.
M
M
Rugge
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
M
M
Zuin
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
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I
Maretto
Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
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D
Nitti
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000009:adverse effects; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D055815:Young Adult
30-day readmission; Colorectal cancer; Colorectal surgery; In-hospital mortality; Length of stay