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Readmission rates and cost following colorectal surgery.
Dis Colon Rectum 2011; 54(12):1475-9DC

Abstract

BACKGROUND

Hospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions.

OBJECTIVE

We designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery.

STUDY DESIGN/SETTING

We reviewed commercial health insurance records of 10,882 patients who underwent colorectal surgery over a 7-year period (2002-2008).

PATIENTS

All patients undergoing colon and/or rectal resection ages 18 to 64 were included.

MAIN OUTCOME MEASURE

The 30-day and 90-day readmission rates, the number of readmissions per patient, the median cost, length of stay, and risk factors for readmission were analyzed.

RESULTS

Thirty-day readmission occurred in 11.4% (1239/10,882) of patients. Readmission between 31 and 90 days occurred in an additional 11.9% (1027/10,882) of patients for a total 90-day readmission rate of 23.3%. Two or more readmissions occurred in 1.4% (155) and 5.2% (570) of patients in the first 30 and 90 days. Mean readmission length of stay was 8 days, and the median cost per stay was $8885. Initial hospitalization risk factors for readmission were the diagnosis of a surgical site infection (OR 1.2), creation of a stoma (OR 1.2), discharge to nursing home (OR 1.2), index admission length of stay >7 days (OR 1.2), proctectomy (OR 1.1), and severity of illness score (severity of illness 3 = OR 1.1; severity of illness 4 = OR 1.3).

CONCLUSIONS

Readmission after colorectal surgery occurs frequently and is associated with a cost of approximately $9000 per readmission. Nationwide these findings account for $300 million in readmission costs annually for colorectal surgery alone. Clinical and systems-based prevention strategies are needed to reduce readmission.

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    Authors+Show Affiliations

    Wick EC
    Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ewick1@jhmi.edu
    Shore AD
    No affiliation info available
    Hirose K
    No affiliation info available
    Ibrahim AM
    No affiliation info available
    Gearhart SL
    No affiliation info available
    Efron J
    No affiliation info available
    Weiner JP
    No affiliation info available
    Makary MA
    No affiliation info available

    MeSH

    AdultColectomyColonDigestive System Surgical ProceduresFemaleHospital CostsHumansInsurance, HealthLength of StayLogistic ModelsMaleMiddle AgedPatient ReadmissionQuality Indicators, Health CareRectumRisk FactorsUnited StatesYoung Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22067174

    Citation

    Wick, Elizabeth C., et al. "Readmission Rates and Cost Following Colorectal Surgery." Diseases of the Colon and Rectum, vol. 54, no. 12, 2011, pp. 1475-9.
    Wick EC, Shore AD, Hirose K, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011;54(12):1475-9.
    Wick, E. C., Shore, A. D., Hirose, K., Ibrahim, A. M., Gearhart, S. L., Efron, J., ... Makary, M. A. (2011). Readmission rates and cost following colorectal surgery. Diseases of the Colon and Rectum, 54(12), pp. 1475-9. doi:10.1097/DCR.0b013e31822ff8f0.
    Wick EC, et al. Readmission Rates and Cost Following Colorectal Surgery. Dis Colon Rectum. 2011;54(12):1475-9. PubMed PMID: 22067174.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Readmission rates and cost following colorectal surgery. AU - Wick,Elizabeth C, AU - Shore,Andrew D, AU - Hirose,Kenzo, AU - Ibrahim,Andrew M, AU - Gearhart,Susan L, AU - Efron,Jonathan, AU - Weiner,Jonathan P, AU - Makary,Martin A, PY - 2011/11/10/entrez PY - 2011/11/10/pubmed PY - 2011/12/28/medline SP - 1475 EP - 9 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 54 IS - 12 N2 - BACKGROUND: Hospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions. OBJECTIVE: We designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery. STUDY DESIGN/SETTING: We reviewed commercial health insurance records of 10,882 patients who underwent colorectal surgery over a 7-year period (2002-2008). PATIENTS: All patients undergoing colon and/or rectal resection ages 18 to 64 were included. MAIN OUTCOME MEASURE: The 30-day and 90-day readmission rates, the number of readmissions per patient, the median cost, length of stay, and risk factors for readmission were analyzed. RESULTS: Thirty-day readmission occurred in 11.4% (1239/10,882) of patients. Readmission between 31 and 90 days occurred in an additional 11.9% (1027/10,882) of patients for a total 90-day readmission rate of 23.3%. Two or more readmissions occurred in 1.4% (155) and 5.2% (570) of patients in the first 30 and 90 days. Mean readmission length of stay was 8 days, and the median cost per stay was $8885. Initial hospitalization risk factors for readmission were the diagnosis of a surgical site infection (OR 1.2), creation of a stoma (OR 1.2), discharge to nursing home (OR 1.2), index admission length of stay >7 days (OR 1.2), proctectomy (OR 1.1), and severity of illness score (severity of illness 3 = OR 1.1; severity of illness 4 = OR 1.3). CONCLUSIONS: Readmission after colorectal surgery occurs frequently and is associated with a cost of approximately $9000 per readmission. Nationwide these findings account for $300 million in readmission costs annually for colorectal surgery alone. Clinical and systems-based prevention strategies are needed to reduce readmission. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/22067174/Readmission_rates_and_cost_following_colorectal_surgery_ L2 - http://dx.doi.org/10.1097/DCR.0b013e31822ff8f0 DB - PRIME DP - Unbound Medicine ER -