BACKGROUND: Decreasing readmissions is an important quality improvement strategy. Targeted interventions that effectively decrease readmissions have not been fully investigated and standardized. OBJECTIVE:The purpose of this study was to assess the effectiveness of interventions designed to decrease readmissions after colorectal surgery.DESIGN: This was a retrospective comparison of patients before and after the implementation of interventions.

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Background Management of the bladder defect during colectomy for colovesical fistula (CVF) and recommendations for duration of urinary catheter drainage are inconsistent. This study aimed to determine if urinary catheter drainage duration was associated with postoperative complications. Methods Retrospective single institution cohort study of patients undergoing resection for diverticular CVF from 2015 through 2021. Urinary catheter drainage was defined as Early (≤7 days postoperative and then subdivided into 1-2 days, 3-5 days, 6-7 days), and Late (>7 days postoperative). Primary outcome was a composite measure of postoperative bladder leak, surgical site infection-III, sepsis, reoperation, and postoperative length-of-stay ≥7 days. Results There were 73 patients—64 Early group and 9 Late group. Composite measure between groups (Early 25% vs Late 33.33%, P = .688) was not significantly different. The Late group had more patients with large bladder defects (33.3% vs 7.8%, P = .054), significantly more patients who underwent suture repair (55.6% vs 14.1%, P = .01), and significantly more patients that had an intraoperative pelvic drain (66.7% vs 15.6%, P = .003). After propensity score inverse weighting, the Late group had significantly more cystogram-detected postoperative bladder leaks ( P = .002) and ileus ( P = .042) than the Early group. There were no bladder leaks or ileus in those who had urinary catheter removal on postoperative days 1-2. Conclusions Early urinary catheter removal was associated with no increase in bladder leaks and fewer postoperative complications after definitive management of CVF. Further investigation is required to determine if intraoperative bladder leak testing and postoperative cystograms are useful adjuncts in decision making.

Objective: The etiology of infantile inferior vena cava (IVC) occlusion remains unclear as it relates to congenital atresia or acute venous thromboembolism (VTE). The natural history of IVC occlusion, including the risk of recurrent VTE and post-thrombotic syndrome, similarly remains poorly defined. This study aimed to better elucidate these features to aid with treatment recommendations.Methods: A single-institution retrospective review of pediatric IVC occlusion was performed between 2000 and 2015. Patients with superior vena cava interruptions were excluded. The electronic medical record was surveyed, and primary end points included VTE, hemorrhage, and death.Results: There were 47 patients diagnosed with IVC occlusion (mean age, 3 years), the majority of whom were infants at the time of diagnosis (n ¼ 27). In this infantile cohort, median age at diagnosis was 28 days, and median weight was 2.3 kg. Specific infantile risk factors included prematurity (33%), sepsis (48%), and intensive care unit admission (96%). Twelve infants (44%) were symptomatic, and seven (26%) had renal vein thrombosis. No infant was treated with thrombolysis, and 63% were managed with anticoagulation. One infant suffered nonfatal hemorrhagic stroke during early anticoagulation. The majority of IVC occlusions were diagnosed with magnetic resonance imaging; duplex ultrasound and computed tomography imaging were additionally employed. Additional risk factors across the cohort included hypercoagulable state (15%), malignant disease (17%), and family history (17%). The incidence of VTE was 13% (n ¼ 6) at a median age of 15 years (range, 9-17); five of these six patients had identifiable hypercoagulable state. Three patients underwent successful thrombolysis for extensive acute iliofemoral deep venous thrombosis, and two required caval recanalization (stenting) for lower extremity swelling with relief of symptoms. Two patients presented with venous aneurysm (one ruptured) requiring treatment. During a mean follow-up of 3 years (range, 0-17 years), there were no late hemorrhagic complications with prolonged anticoagulation, no episodes of recurrent VTE after treatment, and one case of post-thrombotic syndrome. Twelve patients (25%) died of causes unrelated to IVC occlusion.Conclusions: Conventional VTE risk factors accompany pediatric IVC occlusion. Lower extremity deep venous thrombosis complicates a minority of cases, often during the teenage years. Indefinite anticoagulation for pediatric IVC occlusion is likely unnecessary for those patients who lack identifiable hypercoagulable state.