Can Large Database Studies Help Us Decrease Readmissions After Colorectal Surgery?

Abstract

t he current focus on hospital readmission as a proxy for quality of care has encouraged surgeons from nearly every surgical specialty to reexamine their postoperative outcomes. studies on surgical readmissions show that postoperative complications, when included in the analysis, independently predict readmissions, and usually with large effect estimates. 1-3 in fact, postoperative complications have been shown to be more important than patient demographics through the use of statistical model diagnostic tests. 4 Programs that significantly reduce complications are therefore very likely to reduce readmissions. Because not all complications are preventable, opportunities to mitigate the effects of complications through early detection or patient education may also be helpful.Bliss and colleagues use florida state hospital claims data to study risk factors for and costs related to readmission after colorectal surgery in 93,913 patients. 5 their choice of a population-based data source reassures us that a complete capture of readmissions is likely. this is an important strength of the study because approximately 25% of readmitted postoperative patients are cared for at hospitals different from the index hospital. 6,7 Postoperative (either pre-or postdischarge) complications were not part of their multivariable analysis. in light of previous research that shows the strong correlation between postoperative complications and readmissions, one might question the usefulness of an analysis that does not account for these complications. in their adjusted multivariable model, young age (<65 years), nonwhite race, medicare or medicaid insurance, and comorbidities were the patient factors that predicted readmission. With the exception of young age, these are all typical risk factors for complications after colorectal surgery. in addition, patients who had ischemia, volvulus, iBD, Gi bleed, or obstruction as the indication for surgery, and those who had a stoma created (19% of the cohort), rectal resection, or total colectomy had the highest odds of readmission. interventions targeted toward these patients may be higher yield. Data on the interval between hospital discharge and readmission shows us that the median time to first readmission for dehydration was 4 days. therefore, surgeons and hospitals should not be surprised that a plan for a postoperative clinic visit 2 weeks after discharge, for example, would be insufficient to potentially prevent these readmissions.an inherent limitation of administrative data sets is that we have no information on nonbillable variables related to the care transition between inpatient and outpatient settings of care. Pertinent unmeasured variables related to processes of care may include the timing of the postoperative clinic visit and whether this was scheduled at discharge, the quality of discharge instructions and contingency planning for symptoms, 8 telephone follow-up of recently discharged patients, and the processes related to providers involved in the decision surrounding an emergen...

A Single-Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

“…Decreasing readmission rates after colorectal surgery depends on understanding the predictors and reasons for readmissions, 20% to 35% of which are modifiable or preventable. 5,12,13…”

“…[7][8][9][10][11] Decreasing readmission rates after colorectal surgery depends on understanding the predictors and reasons for readmissions, 20% to 35% of which are modifiable or preventable. 5,12,13 Readmissions after colorectal surgery are often in the first week after discharge well before the first postoperative clinic visit. A chart review of all colorectal surgery readmissions at our institution over a 2-year period revealed that ileus, dehydration, postoperative pain, and surgical site infections were the most common readmission diagnoses.…”