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Early discharge and hospital readmission after colectomy for cancer.
Dis Colon Rectum 2011; 54(11):1362-7DC

Abstract

BACKGROUND

Early discharge after colectomy has been shown to be feasible in studies from specialty centers, but we hypothesized that benefits of early discharge might be offset by higher risk of readmission in the surgical community as a whole. Minimizing readmissions is a national health policy priority.

OBJECTIVE

This study aimed to determine whether hospitals discharging patients early had increased readmission rates.

DESIGN

Patients undergoing colectomy surgery for cancer were studied using national Medicare data (MEDPAR database). Multiple logistic regression was performed to determine whether hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) had increased readmission rates. Results were adjusted for patient comorbidity, emergency operation, laparoscopic surgery, demographic factors, and complications. A separate analysis at the patient level was conducted to determine risk factors for readmission.

SETTINGS

Early discharge rates at US acute care hospitals were investigated.

PATIENTS

Patients 65 and older undergoing colectomy surgery for cancer (2003-2008, n = 477,461) were included.

MAIN OUTCOME MEASURE

The main outcome measure was 30-day, all hospital readmission rates.

RESULTS

Hospitals with a pattern of early discharge (median length of stay ≤ 5 d) were not found to have a higher risk-adjusted readmission rate than hospitals with the usual median length of stay (16.3% vs 15.7%, P = .077). However, changing the cutoff for "early discharge" to ≤ 4 days revealed an increased risk for readmission among "very early discharge" hospitals (risk-adjusted readmission rate 21.3% vs 15.7%, P < .001). At the patient level, independent risk factors for readmission included older age, male sex, black race, lower socioeconomic status, urgent/emergent surgery, comorbidities, complications, open (vs laparoscopic) surgery, and longer length of stay for the index hospitalization.

LIMITATIONS

Limitations of this study included the limitations of the administrative data and elderly population.

CONCLUSIONS

Hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) do not have a higher risk-adjusted readmission rate than other hospitals. These results support the safety of early discharge programs in the Medicare population.

Authors+Show Affiliations

Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. hendren@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

21979179

Citation

Hendren, Samantha, et al. "Early Discharge and Hospital Readmission After Colectomy for Cancer." Diseases of the Colon and Rectum, vol. 54, no. 11, 2011, pp. 1362-7.
Hendren S, Morris AM, Zhang W, et al. Early discharge and hospital readmission after colectomy for cancer. Dis Colon Rectum. 2011;54(11):1362-7.
Hendren, S., Morris, A. M., Zhang, W., & Dimick, J. (2011). Early discharge and hospital readmission after colectomy for cancer. Diseases of the Colon and Rectum, 54(11), pp. 1362-7. doi:10.1097/DCR.0b013e31822b72d3.
Hendren S, et al. Early Discharge and Hospital Readmission After Colectomy for Cancer. Dis Colon Rectum. 2011;54(11):1362-7. PubMed PMID: 21979179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early discharge and hospital readmission after colectomy for cancer. AU - Hendren,Samantha, AU - Morris,Arden M, AU - Zhang,Wenying, AU - Dimick,Justin, PY - 2011/10/8/entrez PY - 2011/10/8/pubmed PY - 2011/12/13/medline SP - 1362 EP - 7 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 54 IS - 11 N2 - BACKGROUND: Early discharge after colectomy has been shown to be feasible in studies from specialty centers, but we hypothesized that benefits of early discharge might be offset by higher risk of readmission in the surgical community as a whole. Minimizing readmissions is a national health policy priority. OBJECTIVE: This study aimed to determine whether hospitals discharging patients early had increased readmission rates. DESIGN: Patients undergoing colectomy surgery for cancer were studied using national Medicare data (MEDPAR database). Multiple logistic regression was performed to determine whether hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) had increased readmission rates. Results were adjusted for patient comorbidity, emergency operation, laparoscopic surgery, demographic factors, and complications. A separate analysis at the patient level was conducted to determine risk factors for readmission. SETTINGS: Early discharge rates at US acute care hospitals were investigated. PATIENTS: Patients 65 and older undergoing colectomy surgery for cancer (2003-2008, n = 477,461) were included. MAIN OUTCOME MEASURE: The main outcome measure was 30-day, all hospital readmission rates. RESULTS: Hospitals with a pattern of early discharge (median length of stay ≤ 5 d) were not found to have a higher risk-adjusted readmission rate than hospitals with the usual median length of stay (16.3% vs 15.7%, P = .077). However, changing the cutoff for "early discharge" to ≤ 4 days revealed an increased risk for readmission among "very early discharge" hospitals (risk-adjusted readmission rate 21.3% vs 15.7%, P < .001). At the patient level, independent risk factors for readmission included older age, male sex, black race, lower socioeconomic status, urgent/emergent surgery, comorbidities, complications, open (vs laparoscopic) surgery, and longer length of stay for the index hospitalization. LIMITATIONS: Limitations of this study included the limitations of the administrative data and elderly population. CONCLUSIONS: Hospitals with a pattern of early discharge (median length of stay ≤ 5 d after surgery) do not have a higher risk-adjusted readmission rate than other hospitals. These results support the safety of early discharge programs in the Medicare population. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/21979179/Early_discharge_and_hospital_readmission_after_colectomy_for_cancer_ L2 - http://dx.doi.org/10.1097/DCR.0b013e31822b72d3 DB - PRIME DP - Unbound Medicine ER -