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Readmission After Colectomy: Predictors of a Costly and Common Outcome
*Lillias H Maguire1, *Lindsay A Bliss2, *Zeling Chau3, *Sing Chau Ng2, *Deborah A Nagle2, *Andrew T Chan1, Jennifer F Tseng2
1Massachusetts General Hospital, Boston, MA;2Beth Israel Deaconess Medical Center, Boston, MA;3UMass Memorial Medical Center, Worcester, MA
Objective: Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. This study analyzes risks for readmission following colorectal surgery.
Design: Retrospective cohort study of all elective and non-elective colectomy and/or proctectomy patients in the Healthcare Cost and Utilization Project (HCUP) Florida State Inpatient Database 2007-2011. Readmission defined as inpatient admission within 30 days of discharge. Univariate analyses of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis performed by logistic regression. Sensitivity analysis of non-emergent admissions.
Settings: Florida acute care hospitals
Patients: Colectomy patients 2007-2011.
Intervention(s): None.
Main Outcome Measure(s): Readmission, cost of readmission.
Results: 80,583 patients underwent colectomy. 15.2% were readmitted within 30 days. From 2007 to 2011, readmission rates increased from 13.9% to 15.5% (p64 was negatively associated with readmission (OR 0.80, 95% CI 0.75-0.86). Patients with Medicare, irrespective of age, or Medicaid were more likely to be readmitted than those with private insurance (p<0.0001). Patients with longer index admissions and those undergoing total colectomy or abdominoperineal resection were more likely to be readmitted. High volume hospitals had higher rates of readmission (p<0.0001). Most common reason for readmission was infection (33.13%). Median cost of readmission care was $7,106 (IQR $4,247 -$13,348). Fistulas caused the most costly readmissions ($14,752; IQR $6,615-$27,642).
Conclusions: Readmissions after colorectal surgery are increasing, frequent and costly. Non-private insurance, IBD, extensive procedures, and high hospital volume are significantly associated with readmission.
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