E. M. Hechenbleikner1,2,3, C. Zheng1,2,3, S. P. Lawrence1,2,3, Y. K. Hong1,2,3, L. B. Johnson1,2,3, W. B. Al-Refaie1,2,3 1Georgetown University Medical Center,Washington, DC, USA 2Georgetown University Medical Center, MH-SORC,Washington, DC, USA 3Georgetown University Medical Center, MGUH,Washington, DC, USA
Introduction:
Minority-serving hospitals (MSH) reportedly have higher readmission rates after surgical procedures including colectomy; however, little is known about the contribution of hospital characteristics to the elevated risk of readmission. This study sought to explore the extent to which hospital factors drive readmissions after colorectal resections performed at MSH in the context of patient- and procedure-related factors.
Methods:
Over 168,500 patients who underwent colon or rectal resections in 374 California hospitals between 2004 and 2011 were analyzed, utilizing records from the State Inpatient Database and American Hospital Association Hospital Survey. Stepwise logistic models were built to determine the associations between MSH and 30-day, 90-day, and repeated readmissions, adjusting for patient, procedure, and hospital factors gradually. MSH were defined as hospitals with highest proportion (top decile) of Black and Hispanic patients.
Results:
Among all patients, 88.5% underwent colon resections, 85.8% had open procedures, and 17.7% ostomies. Overall 30-day, 90-day, and repeated readmission rates were 11.2%, 16.9%, and 2.9%, respectively. Odds for 30-day, 90-day and repeated readmissions after colorectal resections were 22%, 21% and 38% more likely at MSH vs. non-MSH, respectively (all p <0.01). Patient factors accounted for up to 74% percent of the observed increase in odds for readmission after colorectal resections at MSH; in contrast, hospital-level factors contributed only 20% after controlling for patient and procedure factors (Table 1).
Conclusion:
Patient-level factors appeared to dominate the increased readmission risk following colorectal resections performed at MSH while hospital factors were less contributory. These findings need to be further validated to shape quality improvement interventions to decrease readmissions.
