GSBS Dissertations and Theses

Approval Date

6-25-2014

Document Type

Master's Thesis

Academic Program

Master of Science in Clinical Investigation

Department

Surgery

First Thesis Advisor

Fred Anderson, PhD

Keywords

Colorectal Surgery, Cost of Illness, Health Care Costs, Hospital Costs, Hospitalization, Outcome Assessment (Health Care), Patient Readmission

Subjects

Theses, UMMS; Colorectal Surgery; Cost of Illness; Health Care Costs; Hospital Costs; Hospitalization; Outcome Assessment (Health Care); Patient Readmission

Abstract

Background: Following passage of the Affordable Care Act in 2010, 30-day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements. We examined the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery (CRS).

Methods: The University HealthSystem Consortium database was queried for adults (≥ 18 years) who underwent colorectal resection for cancer, diverticular disease, inflammatory bowel disease, or benign tumors between January 2008 and December 2011. Our outcomes of interest were readmission within 30-days of the patient’s index discharge, hospital readmission outcomes, and total direct hospital costs.

Results: A total of 70,484 patients survived the index hospitalization after CRS during the years under study, 13.7% (9,632) of which were readmitted within 30 days of discharge. The strongest independent predictors of readmission were: LOS ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.53; 95% CI 1.45-1.61), and discharge to skilled nursing (OR 1.63; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.54-3.40). Of those readmitted, half occurred within 7 days of the index admission, 13% required ICU care, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was over twice as high ($26,917 v. $13,817) for readmitted than for nonreadmitted patients.

Conclusions: Readmissions following colorectal resection occur frequently and incur a significant financial burden on the healthcare system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating healthcare costs.

Categorization: Outcomes research; Cost analysis; Colon and Rectal Surgery

DOI

10.13028/M25P5G

Rights and Permissions

Copyright is held by the author, with all rights reserved.

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