Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs
Senior Scholars Program; School of Medicine; Department of Surgery
Karim Alavi, MD/Surgery
Medical Subject Headings
Cohort Studies; *Colectomy; Comorbidity; Cost of Illness; Female; Hospital Costs; Humans; *Intestinal Diseases; Length of Stay; Male; Middle Aged; Outcome Assessment (Health Care); Patient Discharge; *Patient Readmission; *Postoperative Complications; Reoperation; Risk Factors; Severity of Illness Index; Time Factors; United States
Clinical Epidemiology | Health Services Research | Surgery
BACKGROUND: After passage of the Affordable Care Act, 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.
OBJECTIVE: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.
DESIGN: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery.
SETTINGS: This study was conducted at an academic hospital and its affiliates.
PATIENTS: Adults > /=18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study.
MAIN OUTCOME MEASURES: Readmission within 30 days of index discharge was the main outcome measured.
RESULTS: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay > /=4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients.
LIMITATIONS: Follow-up was limited to 30 days after initial discharge.
CONCLUSIONS: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.
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Citation: Dis Colon Rectum. 2014 Dec;57(12):1421-9. doi: 10.1097/DCR.0000000000000251. Link to article on publisher's site
Damle, Rachelle N.; Cherng, Nicole B.; Flahive, Julie; Davids, Jennifer S.; Maykel, Justin A.; Sturrock, Paul R.; Sweeney, W. Brian; and Alavi, Karim, "Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs" (2014). University of Massachusetts Medical School. Senior Scholars Program. Paper 225.