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Predictive Factors and Outcomes of Unplanned Readmissions in a High-Volume Colorectal Unit
Cigdem Benlice*, Emre Gorgun, Dilara Seyidova-Khoshknabi, Luca Stocchi, Feza H. Remzi
Cleveland Clinic, Cleveland, OH
Background: Thirty-day readmission following colorectal surgery occurs frequently and causes a significant financial burden on the healthcare system. The purpose of this study is to analyze demographics and operative outcomes of patients focusing on the readmission status, and identify procedure specific risk factors.
Methods: All patients who underwent colon and rectal surgery at the department of colorectal surgery between 01/2011 and 12/2013 were identified from our prospectively maintained institutional database. Patients with lost to follow-up or death within 30-day after surgery, and perianal operations were excluded. Demographics and outcomes were compared based on their readmission status. Additionally, readmitted patients were further analyzed for specific readmission related outcomes including; diagnosis, time to readmission and length of readmission stay.
Results: A total of 6637 patients met study inclusion criteria with a mean age of 51.2 (±17.1) years [3420 (51.5%) female]. 775 (11.7%) patients were readmitted at least once within 30 days. Most common index procedures related to readmissions were stoma closure (16.3%) and total colectomy (13.5%). Readmitted patients had longer LOS (p<0.001) and operative time (p<0.001), higher intraoperative (p=0.04) and postoperative complication rates (p<0.001) (Table). 89.4 % of readmitted patients had at least one postoperative complication compared to 36 % complication rate of non-readmitted patients (p<0.001). Main readmission diagnoses were gastrointestinal-related causes (31.7%), small bowel obstruction (15.7%), wound complications (10.8%), and dehydration (8.6%). 83% of patients were readmitted to our own department whereas 11% to other services and 6% to an outside hospital. Median readmission LOS was 4 (1-71) days. 54% (N=407) of readmissions occurred within 7 days of discharge. Those readmitted within 7 days had longer length of readmission stay (p=0.008) and higher complication rates related to the index procedure (p=0.03).
Conclusion: Implementing best practice cultures to decrease postoperative complication rates may play the most important role in reducing hospital readmissions and improve patient care and overall quality.
Table. Comparison of demographics and postoperative outcomes between patients who were readmitted or not
| Readmitted patients
(N=775)
| Non-readmitted patients
(N=5862)
| P value | | Age (year) | 48.6 (±17) | 51.5 (±17) | <0.001 | | BMI (kg/m2) | 27.1 (±6.7) | 26.4 (±6.2) | 0.02 | | Gender (Female) | 401 (51.7%) | 3019 (51.5) | 0.9 | | ASA score | | | 0.003 | | I | 4 (0.5%) | 56 (1%) | | | II | 316 (42.1%) | 2533 (44.6%) | | | III | 372 (49.6%) | 2817 (49.6%) | | | IV | 58 (7.7%) | 271 (4.8%) | | | Diagnosis | | | 0.01 | | Other benign diseases | 290 (37.5%) | 2404 (41%) | | | Colorectal cancer | 134 (17.3%) | 1130 (19.3%) | | | Ulcerative colitis | 171 (22%) | 1032 (17.6%) | | | Crohn's disease | 117 (15.1%) | 819 (14%) | | | Diverticulitis | 63 (8.1%) | 477 (8.1%) | | | Emergency | 30 (4.9%) | 158 (3.3%) | 0.06 | | Surgical Approach | | | 0.96 | | Laparoscopic approach | 236 (30.5%) | 1193 (30.6%) | | | Open procedure | 539 (69.5%) | 4669 (69.4%) | | | Operative time (min) | 166.9 (±104) | 143.6 (±95) | <0.001 | | Length of stay (day) | 8.2 (±5.9) | 7.9 (±6.9) | <0.001 | | Reoperation | 98 (12.6%) | 310 (5.3%) | <0.001 | | Postoperative complication | 693 (89.4%) | 2114 (36%) | <0.001 | | Intraoperative complication | 17 (2.2%) | 73 (1.3%) | 0.04 |
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