H. Xing1, Y. Sanaiha1, Y. Seo1, H. Khoury1, S. E. Rudasill1, A. L. Mardock1, R. Morchi2, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiothoracic Surgery,Los Angeles, CA, USA 2University Of California – Irvine,General Surgery,Orange, CA, USA
Introduction:
Ostomy creation is a common colorectal procedure that is associated with significant postoperative complications. However, unplanned rehospitalization, a surrogate for quality of care, following colostomy creation remains generally unexplored. The present study aimed to characterize the short-term readmissions following colostomy creation and identify the associated outcomes and resource utilization with a national cohort.
Methods:
The Nationwide Readmissions Database (NRD), an all-payer hospitalization database, was used to identify patients who received a colostomy from 2010 to 2015. Patients were stratified by discharge-to-readmission interval: Immediate (within 7 days) and Delayed (8-30 days). Logistic regression analysis was used to account for patient, hospital, and operative characteristics and to identify predictors of readmission.
Results:
Of an estimated 284,600 patients who received colostomy during the study period, 14.1% were readmitted within 30 days: 5.8% Immediate and 8.3% Delayed. At index hospitalization, Immediate patients were younger (63.3 vs 64.2 y, p<0.001) and had a lower Elixhauser comorbidity index (3.86 vs 3.96, p=0.01). Compared to the Delayed group, the Immediate cohort had a higher incidence of diverticular disease (34.5 vs 31.7%, p<0.001), lower rates of secondary gastrointestinal malignancy (8.3 vs 9.5%, p=0.032), and similar incidence of colon cancer, inflammatory bowel disease (IBD), and intestinal obstruction at initial hospitalization. The Immediate group was more likely to be readmitted for gastrointestinal complications (32.3 vs 28.6%, p<0.001), including a higher incidence of intestinal obstruction (11.7 vs 9.1%, p<0.001), stoma repair (2.3 vs 1.5%, p<0.001), and lysis of peritoneal adhesions (2.6 vs 2.1%, p=0.046). However, the Immediate group had a lower incidence of dehydration (12.2 vs 14.0%, p=0.002), acute kidney injury (16.0 vs 18.9%, p<0.001), and stoma closure (0.7 vs 1.0%, p=0.04) during readmission. The Immediate group experienced a higher readmission mortality rate (6.5 vs 5.5%, p=0.02), length of rehospitalization (8.5 vs 7.7 d, p<0.001), and cost ($16,508 vs 15,321, p=0.001). After adjusting for patient and hospital factors, IBD (OR 1.24, 95% CI 1.06-1.44) was associated with increased odds of Immediate readmission.
Conclusion:
In this national study, 14% of patients who underwent colostomy creation were readmitted within 30 days of discharge. Early readmissions were more likely to be related to gastrointestinal adverse events, including intestinal obstruction and stoma complications requiring repair. Patients admitted within 7 days of discharge experienced a higher unadjusted readmission mortality, length, and costs compared to those readmitted within 8-30 days. Diagnosis of IBD was associated with higher odds of readmission. Targeted readmission reduction programs for patients rehospitalized soon after discharge may improve clinical outcomes and the value of care.