Background
Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6–25% of patients are readmitted after colorectal surgery.
Objective
Define predictors and costs of readmission following colorectal surgery.
Design
Retrospective cohort study of elective and non-elective colectomy and/or proctectomy patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007–2011. Readmission defined as inpatient admission within 30 days of discharge. Univariate analyses of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis performed by logistic regression. Sensitivity analysis of non-emergent admissions.
Settings
Florida acute care hospitals
Patients
Colectomy and proctectomy patients 2007–2011
Intervention(s)
None
Main Outcome Measure(s)
Readmission, cost of readmission
Results
93,913 patients underwent colectomy. 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6% to 14.2%, trend p=0.1585). After multivariate adjustment, patient factors associated with readmission included non-white race, age <65, and a diagnosis code other than neoplasm or diverticular disease (p<0.0001). Patients with Medicare or Medicaid were more likely to be readmitted than those with private insurance (p<0.0001). Patients with longer index admissions, those with stomas and those undergoing all procedures other than sigmoid or transverse colectomy were more likely to be readmitted (p<0.0001). High volume hospitals had higher rates of readmission (p<0.0001). Most common reason for readmission was infection (32.9%). Median cost of readmission care was $7,030 (IQR $4,220, $13,247). Fistulas caused the most costly readmissions ($15,174; IQR $6,725, $26,660).
Limitations
Administrative data, retrospective design
Conclusions
Readmissions rates after colorectal surgery remain common and costly. Non-private insurance, inflammatory bowel disease, and high hospital volume are significantly associated with readmission.
