J. D. Owen1, L. E. Goss1, G. D. Kennedy1, J. A. Cannon1, M. S. Morris1, J. S. Richman1, D. I. Chu1 1University Of Alabama at Birmingham,Department Of Surgery,Birmingham, AL, USA
Introduction: Enhanced Recovery After Surgery (ERAS) pathways decrease length-of-stay and readmissions after colorectal surgery. While risk factors such as ostomies have been associated with 30-day readmissions under traditional recovery pathways, it is unclear if these readmission factors remain the same with ERAS pathways. We hypothesized that risk factors for 30-day readmissions under ERAS would differ from pre-ERAS risk factors.
Methods: Using a single-institution colorectal database, we identified all patients who underwent ERAS in 2015 and matched to pre-ERAS patients from 2010-2014 by age, sex, race/ethnic group and procedure type. Patient/procedure-specific characteristics were obtained. The primary outcome was 30-day readmissions. Pre-ERAS and ERAS patients were each stratified by readmission status and univariate and bivariate comparison were made. Multivariate regression was used to identify independent predictors of 30-day readmissions for each cohort.
Results:Of 395 patients, 198 patients underwent ERAS and were matched to 197 Pre-ERAS patients. Overall, the 30-day readmission rate was 15.7% and similar between ERAS and Pre-ERAS patients (16.2 vs. 15.2%, p>0.05). Among ERAS patients, readmitted and non-readmitted patients were similar by matched characteristics and smoking status (28.1 vs 17.5%), minimally-invasive approaches (37.5 vs 44.6%) and BMI (mean 28.9 vs 28.3 (p>0.05). Compared to non-readmitted ERAS patients, readmitted ERAS patients had more ostomies (43.3% vs 22.8%), higher ASA classification scores and more government insurance (p<0.05). Among Pre-ERAS patients, readmitted and non-readmitted patients were similar by female status (53.3 vs. 43.7%), smoking status (23.3 vs 22.2%), and hypertension (43.3 vs 48.5%) (p>0.05). Compared to non-readmitted Pre-ERAS patients, readmitted Pre-ERAS patients had a higher proportion of total colectomies (30.0 vs 5.4%) and more ostomies (36.7 vs. 15.6%) (p<0.01). On adjusted comparisons (Table), risk factors for 30-day readmissions for Pre-ERAS patients included procedure type such as total colectomy (Odds Ratio [OR] 7.0, 95%Confidence-Interval [CI] 1.1-41.6) and presence of an ostomy (OR 2.6, 95%CI 1.1-6.1). For ERAS patients, risk factors for 30-day readmissions included government insurance (OR 4.2, 95%CI 1.7-10.6) and presence of an ostomy (OR 3.1, 95%CI 1.5-6.4).
Conclusion:Independent risk factors for readmission varied between the pre-ERAS and ERAS cohorts. The presence of an ostomy, however, remained an important and common risk factor for 30-day readmissions even under ERAS pathways. Improving our post-discharge care of patients with an ostomy may represent an immediately actionable opportunity to reduce readmissions.
