Readmissions Within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements

Abstract

BACKGROUND: Hospital readmission rate is an important quality metric and has been recognized as a key measure of hospital value-based purchasing programs.OBJECTIVE: This study aimed to assess the risk factors for hospital readmission with a focus on potentially preventable early readmissions within 48 hours of discharge.DESIGN: This is a retrospective cohort study. SETTINGS:This study was conducted at a tertiary academic facility with a standardized enhanced recovery pathway.PATIENTS: Consecutive patients undergoing elective major colorectal resections between 2011 and 2016 were included. MAIN OUTCOME MEASURES:Univariable and multivariable risk factors for overall and early (<48 hours) readmissions were identified. Specific surgical and medical reasons for readmission were compared between early and late readmissions. RESULTS:In total, 526 of 4204 patients (12.5%) were readmitted within 30 days of discharge. Independent risk factors were ASA score (≥3; OR, 1.5; 95% CI, 1.1-2), excess perioperative weight gain (OR, 1.7; 95% CI, 1.3-2.3), ileostomy (OR, 1.4; 95% CI, 1-2), and transfusion (OR, 2; 95% CI, 1.4-3), or reoperation (OR, 11.4; 95% CI, 7.4-17.5) during the index stay. No potentially preventable risk factor for early readmission (128 patients, 24.3% of all readmissions, 3% of total cohort) was identified, and index hospital stay of ≤3 days was not associated with increased readmission (OR, 0.9; 95% CI, 0.7-1.2). Although ileus and small-bowel obstruction (early: 43.8% vs late: 15.5%, p < 0.001) were leading causes for early readmissions, deep infections (3.9% vs 16.3%, p < 0.001) and acute kidney injury (0% vs 5%, p = 0.006) were mainly observed during readmissions after 48 hours.LIMITATIONS: Risk of underreporting due to loss of follow-up and the potential co-occurrence of complications were limitations of this study. CONCLUSIONS:Early hospital readmission was mainly due to ileus or bowel obstruction, whereas late readmissions were related to deep infections and acute kidney injury. A suspicious attitude toward potential ileus-related symptoms before discharge and dedicated education for ostomy patients are important. A short index hospital stay was not associated with increased readmission rates.

Prospective Evaluation of Early Complications After Elective Loop Ileostomy: Need to Optimise Loperamide Management?

“…HOS-related complications together with postoperative ileus/obstruction and deep infections are seen as the main reasons for readmission after elective colorectal surgery. 3 The results of our study confirm that morbidity related to the first factor is significant, with HOS-related readmission in three patients (4%) and need for intensive care unit admission in one of them within 1 week after discharge. Additionally, 9 patients (11%) experienced a delay in discharge during elective admission because of HOS which is a known risk factor for readmission.…”

Correlation of postoperative fluid balance and weight and their impact on outcomes

“…The primary outcome was the correlation between cumulative fluid balance (ml) and daily weight (kg) variations. More specifically, weight at POD 2 (previously identified as most predictive cutoff to launch potential counter-regulatory measures) was correlated with fluid balance at POD 1 (most accurately representing perioperative fluid balance) [28][29][30].…”

A Single-Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

“…Hospital readmission is considered a quality metric for hospital value-based purchasing programs. 20 This study demonstrates that interventions designed to target common reasons for readmissions significantly decreased enhanced recovery colorectal surgery readmission rates from 17.82% to 9.98% and ED visits from 23.15% to 14.58%. There was a significant decrease in readmissions due to SSI I/II infections.…”

“…A retrospective cohort study showed that 25% of readmissions occur within 48 hours of discharge and are often due to ileus, whereas readmissions >48 hours after discharge are related to deep SSIs and AKI. 20 Our median time to readmission after discharge was 6 (IQR 3–11) days in the preintervention group and 8 (IQR 3–17) days in the postintervention group. Median time for readmission after discharge (preintervention vs postintervention) for ileus in our study was 2.5 days vs 3 days, and for AKI/dehydration was 7 days vs 15 days.…”