X. L. Baldwin1, P. D. Strassle1, S. Lumpkin1, K. Stitzenberg1 1University Of North Carolina At Chapel Hill,Chapel Hill, NC, USA
Introduction:
Enhanced recovery pathways have led to shorter lengths of stay (LOS) after colorectal surgery. There continues to be controversy about the relationship between LOS and readmission following colorectal surgery. The purpose of this study was to evaluate the association between LOS and readmissions in a nationally representative sample. We hypothesized that shorter LOS would increase readmission rate.
Methods:
Hospitalizations of adult patients aged 18 – 85 years old, who underwent colon and/or rectal resection between January 2010 and August 2015 in the National Readmission Database were eligible for inclusion. Patients who were treated in December, who were not residents of the state in which they underwent surgery, who died, or who had a LOS <1 day were excluded. Multivariable logistic regression was used to assess the effect of LOS on 30-day readmission, adjusting for patient demographics, comorbidities, hospital characteristics, and inpatient complications.
Results:
We assessed 376,376 hospitalizations. Median LOS was 5 days (IQR 4-8) and 14% of patients (n=51,087) were readmitted within 30 days. As LOS increased, the incidence of readmissions also increased (7% patients with 1 day LOS to 29% in patients with LOS ≥20 days, p<0.0001), Figure 1. After adjustment for patient demographics, comorbidities, inpatient complications, and hospital characteristics, a 5-8 day LOS was associated with a 50% increase in odds of 30-day readmission (OR 1.53, 95% CI 1.05, 1.14, p<0.0001), a 9-12 day LOS was associated with a 100% increase in odds (OR 2.06 95% CI 1.99, 2.13, p<0.0001), and a LOS ≥13 days was associated with an almost 150% increase in odds (OR 2.45 95% CI 2.36, 2.55, p<0.0001), compared to a 1-4 day LOS.
Conclusion:
Contrary to our hypothesis, we found that an increased length of stay resulted in increased readmission rates following colorectal surgery. Shorter LOS decreased the odds of 30-day readmission, regardless of a patient’s pre-existing comorbidities and inpatient complications. Future studies should examine factors associated with prolonged hospitalization and identify possible interventions to decrease readmission in these patients.
