Predicting Readmission and Leak Rates Following Colectomy with Red Cell Distribution Width: A Simple but Effective Test

Abstract

Introduction: Prediction of readmission as a result of either delayed presentation of infection, or worse an anastomotic leak is diffi cult. Effi cient reduction in the length of stay and being able to predict problematic patients who may be readmitted or develop complications would be advantageous. To date, other tests including CRP have proven to be insuffi ciently sensitive for this task. Materials & Methods: We performed a single center, retrospective review of patients admitted to a large, urban safety net hospital who underwent colectomy over a two year period to determine the predictive value of red cell distribution width (RDW) on the development of anastomotic leak or readmission within 30 days following hospital discharge. Results: A total of 118 patients underwent colectomy during this period. Readmission and/or anastomotic leak occurred in 49 patients. The sensitivity of elevated RDW levels (greater than or equal to 14.0) at detecting future readmission and/or leak was 89.8%. The negative predictive value for a normalized RDW below 14.0 at predicting the non-occurrence of leak or readmission was 87.7%. The specifi city of an elevated RDW was 72.4% and the positive predictive value was 76.5%. Conclusions: Elevated RDW level is a readily available criterion to predict readmissions and anastomotic leaks following colectomy. A normal RDW is a good predictor of an uncomplicated postoperative course and may potentially allow clinicians to feel more confi dent in early discharge of patients.