D. Peterson1,3, F. Guzman1, L. Yu4, W. Cirocco1, A. Harzman1, A. Traugott1, M. Arnold1, S. Husain1 1Ohio State University,Colon And Rectal Surgery,Columbus, OH, USA 3Penn State Hershey Medical Center,Surgery,York, PA, USA 4Ohio State University,Biostatistics,Columbus, OH, USA
Introduction:
With recent emphasis on pay for performance model for surgery, length of stay and readmission rates have come under renewed scrutiny. An inverse relationship between length of stay and readmission rates has been suggested raising concerns that early discharges may in fact lead to higher readmission rates. We sought to evaluate the relationship between length of stay and readmission rates and the impact of surgical approach, patient demographics and postoperative complications.
Methods:
Retrospective chart review was conducted of all colorectal surgeries from September 1, 2011-August 31, 2016 at a tertiary medical center. Patient demographics, comorbidities, postoperative complications, length of stay and readmission rates were evaluated. Logistic regression used to evaluate continuous predictors and Fisher exact test used to evaluate categorical predictors.
Results:
A total of 1319 patients were included. The average length of stay was 10.3 days (median: 7) and 260 (19.7%). At least one complication was noted in 226 (17.36%) patients. Univariate analysis revealed that longer hospital stays correlated with higher readmission rates (R= 0.015, p= 0.00953). However, this association lost its statistical significance with multivariate analysis (p=0.858). Multivariate analysis also revealed that the both increased length of stay and readmissions were strongly associated with pre-existing patient comorbidities (age, diabetes, BMI, COPD, renal dysfunction) as well as postoperative complications (wound infection, abdominal abscess, SVT, PE, pneumonia, UTI). Furthermore, utilization of laparoscopic surgery had statistically significant association with shorter length of stay and lower readmission rates (p=0.004 and 0.02 respectively).
Conclusion:
While length of stay is associated with readmission rates in univariate analysis, this relationship is lost when factors like patient comorbidities, operative outcomes and surgical approach are taken into consideration. Our results also indicate that pre-existing comorbidities and postoperative complications result in prolonged hospitalization and increased readmission rates. Finally, our study not only confirms the well documented beneficial effect of laparoscopic approach on length of stay, it also indicates that minimally invasive approach results in lower readmission rates. While most pre-existing medical conditions leading to longer hospital stays and readmissions are not modifiable, a concerted effort is necessary to minimize postoperative complications and to promote utilization of minimally invasive platform.