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Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs.
Dis Colon Rectum 2014; 57(12):1421-9DC

Abstract

BACKGROUND

After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements.

OBJECTIVE

The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.

DESIGN

Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery.

SETTINGS

This study was conducted at an academic hospital and its affiliates.

PATIENTS

Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study.

MAIN OUTCOME MEASURES

Readmission within 30 days of index discharge was the main outcome measured.

RESULTS

A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients.

LIMITATIONS

Follow-up was limited to 30 days after initial discharge.

CONCLUSIONS

Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.

Authors+Show Affiliations

1Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 2Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 3Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25380009

Citation

Damle, Rachelle N., et al. "Clinical and Financial Impact of Hospital Readmissions After Colorectal Resection: Predictors, Outcomes, and Costs." Diseases of the Colon and Rectum, vol. 57, no. 12, 2014, pp. 1421-9.
Damle RN, Cherng NB, Flahive JM, et al. Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. Dis Colon Rectum. 2014;57(12):1421-9.
Damle, R. N., Cherng, N. B., Flahive, J. M., Davids, J. S., Maykel, J. A., Sturrock, P. R., ... Alavi, K. (2014). Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. Diseases of the Colon and Rectum, 57(12), pp. 1421-9. doi:10.1097/DCR.0000000000000251.
Damle RN, et al. Clinical and Financial Impact of Hospital Readmissions After Colorectal Resection: Predictors, Outcomes, and Costs. Dis Colon Rectum. 2014;57(12):1421-9. PubMed PMID: 25380009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. AU - Damle,Rachelle N, AU - Cherng,Nicole B, AU - Flahive,Julie M, AU - Davids,Jennifer S, AU - Maykel,Justin A, AU - Sturrock,Paul R, AU - Sweeney,W Brian, AU - Alavi,Karim, PY - 2014/11/8/entrez PY - 2014/11/8/pubmed PY - 2015/2/24/medline SP - 1421 EP - 9 JF - Diseases of the colon and rectum JO - Dis. Colon Rectum VL - 57 IS - 12 N2 - BACKGROUND: After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements. OBJECTIVE: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery. DESIGN: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery. SETTINGS: This study was conducted at an academic hospital and its affiliates. PATIENTS: Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study. MAIN OUTCOME MEASURES: Readmission within 30 days of index discharge was the main outcome measured. RESULTS: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients. LIMITATIONS: Follow-up was limited to 30 days after initial discharge. CONCLUSIONS: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs. SN - 1530-0358 UR - https://www.unboundmedicine.com/medline/citation/25380009/Clinical_and_financial_impact_of_hospital_readmissions_after_colorectal_resection:_predictors_outcomes_and_costs_ L2 - http://dx.doi.org/10.1097/DCR.0000000000000251 DB - PRIME DP - Unbound Medicine ER -