Objective The objective of this study was to identify risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy. Background Postoperative complications have been found to influence timing of chemotherapy in colon cancer patients. Delays in chemotherapy have been shown to be associated with worse overall and disease free survival in colorectal cancer patients, although timing of delay has not been agreed upon in the literature. Study Design We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan Meier curves were generated to compare overall and disease free survival in patients based on complications and timing of chemotherapy. Settings This study was performed at the University of Wisconsin Hospital, Madison, WI between 1995 and 2012. Patients Patients with rectal cancer who underwent proctectomy with curative intent were included in this study. Outcome Measures Timing of chemotherapy, 30 day complications and 30 day readmissions were the main outcome measures. Results Postoperative complications and 30 day readmissions were associated with delays in chemotherapy ≥ 8 weeks after surgery. Patients who received chemotherapy ≥ 8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival as compared with patients who received chemotherapy within 8 weeks of surgery. Limitations Limitations of this study include its retrospective nature and that it was performed at a single institution. Conclusions We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥ 8 weeks postoperatively had worse disease free and overall survival.

Background Thirty day readmissions are common in general surgery patients and affect long term outcomes including mortality. We sought to determine the effect of complication timing on post-operative readmissions. Methods Patients from our institutional ACS NSQIP database who underwent general surgery procedures from 2006–2011 were included. The primary outcome of interest was 30 day hospital readmission. Results Patients diagnosed with post-discharge complications were significantly more likely to be readmitted (56%) compared with patients diagnosed with complications before discharge (7%, p<0.001). Independent predictors of post-discharge complications included laparoscopic case, short hospital stay, pre-operative dyspnea and independent functional status. GI Complications and Surgical Site Infection were the most common reasons for readmission. Conclusions The development of complications after hospital discharge places patients at significant risk for readmission. Early identification and treatment of GI complications and Surgical Site Infections in the outpatient setting may decrease post-operative readmission rates.

BACKGROUND The aim of this study was to characterize patients readmitted following inpatient general surgery procedures. We hypothesized that a decreased length of stay would increase risk for readmission. METHODS We utilized our institutional National Surgical Quality Improvement Project database from 2006 to 2011. The main outcome of interest was 30-day readmission. Univariate and logistic regression analyses identified risk factors for readmission. RESULTS We identified 3,556 patients, with 322 (9%) readmitted within 30 days after discharge. Multivariable analysis demonstrated age, dyspnea, and American Society of Anesthesiologists class to be independent risk factors for readmission. In addition, patients who suffered multiple complications had a decreased risk for readmission as length of stay increased. Patients with <2 postoperative complications had an increased risk for readmission as length of stay increased. CONCLUSIONS Contributors to postoperative readmissions are multifactorial. Perioperative factors predict risk for readmission and may help determine a target length of stay. Prevention of postoperative complications may reduce readmission rates.

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