INCIDENCE AND PREDICTORS OF 30-DAY READMISSION FOLLOWING COLECTOMY FOR COLON CANCER: AN ANALYSIS OF THE NATIONAL READMISSION DATABASE
Harika Kandlakunta1, Chimaobi M. Anugwom2, Itegbemie Obaitan2, Dhruv P. Singh1, Vaibhav Wadhwa3, Sushil Kumar Garg*1
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN; 2Gastroenterology, University of Minnesota, Minneapolis, MN; 3Cleveland Clinic, Fort lauderdale, FL
BACKGROUND: Colon cancer is a lethal disease worldwide and is the third most common cancer diagnosis in men and women in the United States. Colectomy is a major management strategy and may be curative. Readmissions after colectomy can pose significant quality and financial implications. Given the paucity of studies including all patient in the United States that evaluate the relationship between patient characteristics and readmission, we felt the need to evaluate for predictors of 30-day readmission, that include patient, hospital and society-related factors after colectomy for colorectal cancer.
METHODS: We performed a retrospective analysis using the National Readmission Database (NRD), the largest all-payer inpatient database in the United States, to determine if patient demographic and clinical characteristics were predictive of hospital readmission within 30 days for adult patients (Age > 18 years) discharged following colectomy for colorectal cancer. Index stays were identified from 2010 to 2014 and these require "live"? discharge status. Clinical variables were based on secondary diagnoses at the time of the first admission and selected for analysis based on the frequency of occurrence and potential clinical value for risk stratification. The trend of early readmissions during this period was also analyzed and a multivariate regression model predicting readmission was created using all available patient-, hospital-, and procedure-related predictors.
RESULTS: From the National Readmission database (NRD), we found 382711 patients who had colectomy for colorectal cancer between 2010-2014. Of these patients, 49475(12.9%) were readmitted within 30 days. The rate of readmission following colectomy for colorectal cancer was about 13.3% in 2010. This rate did not change substantially over the next four years, with the rate of readmission in 2014 being 12.2%.
On multivariate analysis, compared to male patients, female patients had lower odds of readmission with an odds ratio of 0.90 (0.87 - 0.94). Discharge from the hospital other than routine discharge (skilled nursing facility, short-term hospital, home care or against medical advice) were all associated with higher odds of readmission. The presence of surgical complications {OR 1.165 (1.111 - 1.221)}, small bowel resection {OR 1.348 (1.255 - 1.477)} or septicemia during hospitalization {OR 1.294 (1.244 - 1.461)} were all associated with higher odds of 30-day readmission.
CONCLUSION: From this exploratory study, 49475 patients who are admitted for colectomy for colorectal cancer are readmitted within 30 days. These unplanned early readmissions contribute to the economic burden of colorectal cancer on healthcare. Identifying and addressing these predictors may be valuable in the bid to stymie these readmissions.
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