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.

The utilization of operations for PDT has declined without affecting mortality, but operative morbidity increased significantly over the 12 years to 2009. The development of an evidence-based approach to invasive manoeuvres and an early multidisciplinary approach involving pancreatic surgeons may improve outcomes in patients with these morbid injuries.

Introduction Intraoperative cholangiogram (IOC) can define biliary ductal anatomy. Routine IOC has been proposed previously. However, current surgeon IOC utilization practice patterns and outcomes are unclear. Methods Nationwide Inpatient Sample 2004–2009 was queried for patients with acute biliary disease undergoing cholecystectomy (CCY). Analyses only included surgeons performing ≥10 CCY/year. We dichotomized surgeons into a routine IOC group vs. selective. Outcomes included bile duct injury, complications, mortality, length of stay, and cost. Results Of the nonweighted patients, 111,815 underwent CCY. A total of 4,740 actual surgeon yearly volumes were examined. On average, each surgeon performed 23.6 CCYs and 7.9 IOCs annually, using IOC in 33 % of cases. The routine IOC group used IOC for 96 % of cases, whereas selective IOC group used IOC ~25 % of the time. Routine IOC surgeons had no difference in mortality (0.4 %) or rate of bile duct injury (0.25 vs. 0.26 %), but higher overall complications (7.3 vs. 6.8 %, p=0.04). Patients of routine IOC surgeons received more additional procedures and incurred higher costs. Conclusion Routine IOC does not decrease the rate of bile duct injury, but is associated with significant added cost. Surgeons’ routine use of IOC is correlated with increased rates of postsurgical procedures, and is associated with increased overall complications. These data suggest routine IOC may not improve outcomes.

In spite of a shift to high-volume hospitals, a substantial cohort still receives a resection outside of these centres. Patients receiving non-high-volume care demonstrate less favourable comorbidities, insurance and urgency of operation. The implications are twofold: already disadvantaged patients may not benefit from the high-volume effect; and patients predisposed to do well may contribute to observed superior outcomes at high-volume centres.