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Complications After Hospital Discharge Leading to Readmission in Colorectal Resection Patients: a Review of the ACS-NSQIP Database
Jeanine Arkenbosch^*, Hiromichi Miyagaki, Nipa Gandhi, Melissa M. Alvarez Downing, Hamza Guend, David Y. Lee, Vesna Cekic, H M C. Shantha Kumara, Richard L. Whelan
St Lukes Roosevelt Hospital Center, New York, NY

Background: To reduce costs surgeons strive to shorten the length of stay (LOS). However, the earlier the discharge the greater the number of complications that occur out of hospital. The purpose of this study was to determine the type and proportion of complications that occur after discharge in Colorectal Resection Patients (CRP) and to determine the readmission rate. Methods: The data used for this study was obtained from the NSQIP database which was queried for elective CRP's in 2012. Exclusion criteria were: totally dependent health status, ventilator dependence, sepsis, prior surgery within 30 days, emergency cases and ASA status 4, 5. Demographic parameters, comorbidities, LOS, complications and readmissions were assessed. The Fisher's exact test was used for univariate analysis. Results: A total of 23847 CRP's were identified; indications for surgery were: malignant tumor 50.4%, benign tumor 14.2%, diverticulitis 23.5%, IBD 10.2%, and other 1.7%. The operations performed were: segmental resection, 84.5%; APR/proctectomy 8.7%; and total colectomy 6.8%. Stomas were constructed in 21.8% and laparoscopic methods used in 56.3% of cases. The mean LOS was 6.4±5.4 days and the mortality rate 0.8 %. Unplanned readmission occurred in 10.2% of patients and the reoperation rate was 4.7%. The overall morbidity rate was 24.3%; 40.1% of the complications occurred after discharge. Readmission was required for 49.7% of patients with post-discharge complications. The individual complication data is presented in the following order: 1) the overall rate of the complication in question, 2) the percentage of patients with that complication diagnosed post discharge, and 3) the percentage of patients with that complication who were readmitted. The most frequent complications after discharge were: superficial SSI, 6.8%, 59.7%, 26.6%; sepsis, 3.4%, 36.4%, 92.4%; Organ Space SSI, 4.0%, 49.3%, 88.9%; and UTI, 2.8%, 42.9%, 40.4%. Rarer complications with a high readmission rate were: pneumonia, 1.4%, 18.5%, 71.4%; DVT 1.2%, 47.2%, 73.1%; wound disruption, 1.1%, 51.3%, 59.6%; progressive Renal Insufficiency, 0.7%, 49.7%, 86.4%; Pulmonary Embolism, 0.6%, 46.3%, 88.2%; and CVA/Stroke, 0.2%, 33.3%, 92.3%. Conclusion: Forty percent of complications occurred after discharge and half the affected patients required readmission. The most common late complications were superficial SSI, organ space infection, sepsis, and UTI. The readmission rate for individual complications varied from 26-90 %. It is not clear to what extent discharge delays recognition of the complication and the start of treatment. After discharge, CRP's should be followed closely in order to diagnose and treat late complications early. When assessing costs for inpatient procedures it is critical to include costs associated with late complications including readmission and treatments.

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