S. T. Lumpkin1, P. Strassle1,2, N. Chaumont1 1University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of Epidemiology,Chapel Hill, NC, USA
Introduction: Rates of readmission after colorectal surgery (CRS) range from 9-25%, and cost the US $300 million annually. Our hypothesis is that transfer from an outside hospital prior to CRS, as one potential indicator of preoperative access to care, increases odds of 30-day readmission.
Methods: Using the Healthcare Cost and Utilization Project Nationwide Readmissions Database, a retrospective analysis of surviving adult patients who underwent inpatient CRS from 2010-2014 was performed. The primary outcomes were 30-day risks of cause-specific readmissions, listed in Figure 1. A composite ‘any surgical indication’ variable was created to assess if the primary indication for surgery was also a cause for readmission. Using multivariable logistic regression, we assessed the direct effect of potential risk factors for readmission, including demographics, hospital characteristics, comorbidities, indication for CRS, and initial transfer status to the index hospital where the CRS was performed.
Results: Total n=357,696 patients. The cause-specific rate of readmission was 7.1%, n=25269 (Figure 1). Primary indications for CRS were independent risk factors for readmission: relative to cancer, patients with IBD (OR 2.10, 95% CI 1.99, 2.22) and trauma (OR 1.24, 95% CI 1.08,1.43) were more likely to be readmitted, whereas patients with infectious indications (OR 0.74, 95% CI 0.72, 0.77) and non-infectious/vascular indications (OR 0.77, 95% CI 0.73, 0.81) were less likely to be readmitted. Patients treated at small hospitals were less likely to be readmitted (OR 0.94, 95% CI 0.90, 0.98) than patients treated at large hospitals. Treatment at a rural-nonteaching hospital compared to urban-teaching hospital, (OR 0.75, 95% CI 0.71, 0.79) decreased odds of readmission. Younger patient age, 18-34 years old compared to age 35-49 years old (OR1.13, 95% CI 1.05, 1.21), public primary insurance compared to private insurance (OR 1.27, 95% 1.22, 1.31), and multiple comorbidities were also significantly associated with increased odds of readmission. Two percent of patients were transferred from another hospital to the hospital where CRS was performed; this did not affect odds of 30-day readmission (OR 0.97, 95% CI 0.89, 1.06).
Conclusion: Preoperative considerations, such as primary indications for CRS, are important risk factors for readmission, but transfer status was not significant. At large, urban-teaching hospitals, where patients are at higher risk of readmission, targeting interventions towards patients between the ages 18-34, with public insurance, who have comorbidities, or whose primary indication for surgery is cancer, trauma, or IBD patients may reduce readmissions.
