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. 2012 Mar 26:12:77.
doi: 10.1186/1472-6963-12-77.

Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions

Maria Kelly  1 , Linda Sharp, Fiona Dwane, Tracy Kelleher, Harry Comber
Affiliations

Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions

Maria Kelly et al. BMC Health Serv Res. .

Abstract

Background: The impact of developments in colorectal cancer surgery on length-of-stay (LOS) and re-admission have not been well described. In a population-based analysis, we investigated predictors of LOS and emergency readmission after the initial surgery episode.

Methods: Incident colorectal cancers (ICD-O2: C18-C20), diagnosed 2002-2008, were identified from the National Cancer Registry Ireland, and linked to hospital in-patient episodes. For those who underwent colorectal resection, the associated hospital episode was identified. Factors predicting longer LOS (upper-quartile, > 24 days) for elective and emergency admissions separately, and whether LOS predicted emergency readmission within 28 days of discharge, were investigated using logistic regression.

Results: 8197 patients underwent resection, 63% (n = 5133) elective and 37% (n = 3063) emergency admissions. Median LOS was 14 days (inter-quartile range (IQR) = 11-20) for elective and 21 (15-33) for emergency admissions. For both emergency and elective admissions, likelihood of longer LOS was significantly higher in patients who were older, had co-morbidities and were unmarried; it was reduced for private patients. For emergency patients only the likelihood of longer LOS was lower for patients admitted to higher-volume hospitals. Longer LOS was associated with increased risk of emergency readmission.

Conclusions: One quarter of patients stay in hospital for at least 25 days following colorectal resection. Over one third of resected patients are emergency admissions and these have a significantly longer median LOS. Patient- and health service-related factors were associated with prolonged LOS. Longer LOS was associated with increased risk of emergency readmission. The cost implications of these findings are significant.

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Figures

Figure 1
Figure 1
Project overview.
Figure 2
Figure 2
Median LOS for all admissions by site, admission type and year of surgery.
Figure 3
Figure 3
28 day emergency readmission rates by index episode admission type and year.
See this image and copyright information in PMC

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