What Factors Predict Hospital Readmission after Colorectal Surgery?

Abstract

Readmissions pose a significant hardship for patients and constitute a major quality and financial concern for hospitals. We sought to define risk factors associated with hospital readmission after colorectal surgery at a tertiary care hospital. We evaluated readmission among all patients who underwent a colorectal surgical procedure between July 16, 2007 and June 30, 2011. In a cohort of 4879 operative encounters, 492 (10%) were readmitted to the hospital within 30 days of discharge. Procedures with highest readmissions included stoma creation (22%), ileoanal pouch surgery (22%), and total proctocolectomy (30%). In multivariate analysis, the following variables were associated with risk of readmission: postoperative complication, use of anxiolytics, high comorbidity score, patient setting, alcohol use, and stoma creation. Surgeon of record was not associated with readmission. In conclusion, several patient, procedural, and postoperative factors were associated with an increased risk of readmission. Considerably high rates of readmission were noted after stoma creation, ileoanal pouch procedures, and proctocolectomy. Surgeon of record was not associated with risk of read-mission, indicating little value to this metric as a physician-specific indicator of quality.

Readmission After Elective Ileostomy in Colorectal Surgery Is Predictable

“…Our findings agree with an validate those of previous studies, as preoperative steroid use, history of diabetes or depression, and complications after the index procedure have been individually identified as risk factors for readmission after general surgery procedures. 9 – 11 A new ileostomy and steroid use were identified as a risk factor for readmission in other patients such as those with IBD, 14 as was the case in our study. A recent systematic review identified older age, presence of comorbidities, preoperative immunosuppression, and postoperative complications as risk factors for readmission within 30 days of discharge.…”

“…Our study builds upon previously published work 9 – 11 by focusing on colorectal surgery with elective ileostomy creation, with broader applicability to our specialized practice. We also provide an ileostomy-specific risk calculator (prediction model) for readmission within 30 days of discharge to help identify high-risk patients before surgery, improve physician counseling, and help address risk factors before surgery.…”

“…Current studies assessing risk factors do not provide a specific predictive model and if so, do not focus on patients who have had colorectal surgery, with limited applicability to our specialized practice. 9 – 11 Therefore, we wanted to develop a model for predicting readmission within 30 days of discharge after elective ileostomy creation. Future efforts could then be focused on mitigating readmissions by influencing modifiable factors identified in our model.…”

Predictors of short-term readmission after beyond total mesorectal excision for primary locally advanced and recurrent rectal cancer

“…Post-operative morbidity and the need for reinterventions, in fact, affected the risk of readmission after colorectal surgery in several studies [11, 22, 23]. Similarly, amongst our patients a strong association was found between the risk of 30-day readmission and the presence of any morbidity during the first recovery as well as the need for re-interventions.…”

Can We Improve Prediction of Adverse Surgical Outcomes? Development of a Surgical Complexity Score Using a Novel Machine Learning Technique

“…[1][2][3][4] In addition, quality measures, such as prolonged hospital length of stay and unplanned readmissions, are more prevalent among patients with multiple comorbidities and those individuals who experience a postoperative complication. [5][6][7] Equally as important, the incidence of perioperative complications may cause a reduction in both quality of life and overall survival. [8][9][10][11] The wideranging impact of postoperative complications underscores the need for appropriate preoperative risk stratification to improve patient selection, and to educate and allow for informed patient consent.…”