Purpose: To determine whether readmission to the same hospital as the index resection results in better outcomes following resection for rectal cancer. Methods: All patients undergoing surgical resection for rectal cancer in California (1994-2005) were retrospectively identified by ICD-9 procedure codes (48.5, 48.61-48.69) using the California Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database linked with the California Cancer Registry and 2000 US Census. Univariate and logistic multivariate analysis were used to determine significant outcome predictors.Results: 24,368 patients underwent resection for rectal cancer in 1994-2005. 9,608 (39%) had at least one readmission within the first year (11% within 30 days, 21% within 90 days, median time to first readmission 74d). For all patients who were readmitted, 85% had a surgical complication and 40% required a rectal cancer resection-related procedure. The most common procedures were peritoneal adhesiolysis, percutaneous abdominal drainage, large bowel stoma revision, and partial large bowel excision. 81% of patients returned to the index hospital for their first readmission. Index hospital readmission was associated with significantly lower 1yr mortality (15.9% vs. 20.8%, p<0.001) and 7% shorter length of stay (p<0.008) compared with patients readmitted to a different hospital. Multivariate logistic regression confirmed lower 1yr mortality with return to the index hospital controlling for revised Charlson score, age, cancer stage, hospital volume, and unscheduled admission (Odds Ratio: 0.92, p<0.002). Patients readmitted within the first 30 days and patients younger than 65 had the most benefit from index hospital readmission with a combined 42% reduction in 1yr mortality (p<0.001). Older age, higher revised Charlson score, higher cancer stage, and unscheduled admission were significant predictors of readmission. Race, poverty, and hospital volume did not predict readmission. Conclusion: Care of the rectal cancer resection patient requires close follow-up and often coordination of multiple medical and surgical services. Continuity of care results in significantly lower long term mortality.