Characterization of Readmission by Day of Rehospitalization After Colorectal Surgery

Al-Mazrou, Ahmed M.; Suradkar, Kunal; Mauro, Christine; Kiran, Ravi P.

doi:10.1097/dcr.0000000000000734

Cited by 29 publications

(19 citation statements)

References 32 publications

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“…The present study adds to the growing body of literature assessing factors associated with readmission timing in major surgery patients. Similar to our present findings, a recent study examining a large cohort of colorectal surgery patients found that demographic differences were minimal between patients readmitted early and late after index discharge, and that GI complications were more prevalent in early readmissions [20]. In that cohort, significant predictors of early vs late readmissions included wound disruption and neurological complications.…”

Section: Discussionsupporting

confidence: 89%

Characterising ‘bounce‐back’ readmissions after radical cystectomy

et al. 2019

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ObjectiveTo examine predictors of early readmissions after radical cystectomy (RC). Factors associated with preventable readmissions may be most evident in readmissions that occur within 3 days of discharge, commonly termed 'bounce-back' readmissions, and identifying such factors may inform efforts to reduce surgical readmissions. Patients and MethodsWe utilised the Healthcare Cost and Utilization Project's State Inpatient Databases to examine 1867 patients undergoing RC in 2009 and 2010, and identified all patients readmitted within 30 days of discharge. We assessed differences between patients experiencing bounce-back readmission compared to those readmitted 8-30 days after discharge using logistic regression models and also calculated abbreviated LACE scores to assess the utility of common readmissions risk stratification algorithms. ResultsThe 30-day and bounce-back readmission rates were 28.4% and 5.6%, respectively. Although no patient or index hospitalisation characteristics were significantly associated with bounce-back readmissions in adjusted analyses, bounceback patients did have higher rates of gastrointestinal (14.3% vs 6.7%, P = 0.02) and wound (9.5% vs 3.0%, P < 0.01) diagnoses, as well as increased index and readmission length of stay (5 vs 4 days, P = 0.01). Overall, the median abbreviated LACE score was 7, which fell into the moderate readmission risk category, and no difference was observed between readmitted and non-readmitted patients. ConclusionOne in five readmissions after RC occurs within 3 days of initial discharge, probably due to factors present at discharge. However, sociodemographic and clinical factors, as well as traditional readmission risk tools were not predictive of this bounce-back. Effective strategies to reduce bounce-back readmission must identify actionable clinical factors prior to discharge.

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Section: Discussionsupporting

confidence: 89%

Characterising ‘bounce‐back’ readmissions after radical cystectomy

et al. 2019

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“…The operation involving digestive tract reconstruction, anastomotic leakage is a potential risk. Once it occurs, reoperation is usually inevitable [ 31 ]. The incidence of anastomotic leakage in NOSE-LAR (3.4%) was similar with that in AISE-LAR (3.4%).…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

Yao

Wang

et al. 2020

World J Surg Onc

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Background Natural orifice specimen extraction surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors. Methods MEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software. Results Ten studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = − 0.38 day (95% CI, − 0.70 to − 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = − 1.64 (95% CI, − 2.31 to − 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = − 0.71 day (95% CI, − 1.10 to − 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR. Conclusions The safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.

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“…A nationwide US study looked at preventable and inevitable readmissions after colorectal surgery and found late readmissions (day 6–29 post‐discharge) to be associated with renal complications, stoma procedures and disseminated cancer – factors that might be identifiable preoperatively. Early readmissions (day 0–5 post‐discharge) were found to be inevitable and related to patient and operative complexity .…”

Section: Discussionmentioning

confidence: 99%

Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery

2018

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Aim The present database study aimed to identify patients with a longer postoperative length of stay (LOS) or patients readmitted and to characterize both groups based on perioperative factors. Method A retrospective review of the Danish Colorectal Cancer Group database and a local database was performed of all patients undergoing elective resection for colorectal cancer in a 25‐month period. The primary outcome was the number of patients with a prolonged hospital stay (LOS ≥ 10 days after the primary operation) and readmissions within 30 days after discharge. Results A total of 372 patients with colon resection and 215 patients with rectal resection were included. Patients undergoing colonic resection had a rate of prolonged hospital stay of 10.6% and a readmission rate of 13.7%; prolonged hospital stay was significantly associated with age ≥ 76 years and those who underwent a conversion from a laparoscopic procedure. Patients undergoing rectal cancer resection had a rate of prolonged hospital stay of 17.7% and a readmission rate of 14.0%; Charlson comorbidity score (CCS) ≥ 2, total mesorectal excision (TME) and laparoscopic conversion were significantly associated with prolonged hospital stay, and American Society of Anesthesiologists (ASA) score ≥ 3, TME and a duration of surgery ≥ 300 min were significantly associated with readmission. Conclusion In patients with colon cancer, older age and conversion to open surgery were associated with prolonged hospital stay. In patients with rectal cancer, CCS ≥ 2, TME and conversion were associated with prolonged hospital stay, and a preoperative ASA score ≥ 3, TME and a duration of surgery ≥ 300 min were associated with readmission.

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Characterization of Readmission by Day of Rehospitalization After Colorectal Surgery

Cited by 29 publications

References 32 publications

Characterising ‘bounce‐back’ readmissions after radical cystectomy

Characterising ‘bounce‐back’ readmissions after radical cystectomy

Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

Prolonged hospital stay and readmission rate in an enhanced recovery after surgery cohort undergoing colorectal cancer surgery

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