Readmission after colorectal surgery is related to preoperative clinical conditions and major complications

Abstract

Background: Hospital readmission is increasingly perceived as a marker of quality and is poorly investigated in patients receiving colorectal surgery.

Objective: The objective of this study was to describe patterns and etiology of readmission, to determine the rate of readmission, and to identify risk factors for readmission after colorectal surgery.

Design: This study is a retrospective medical chart review. Significant (p < 0.1) preoperative and perioperative factors associated with readmission on univariate analysis were examined in a multivariable model.

Setting: The investigation was conducted in a tertiary care hospital.

Patients: Patients included adults undergoing major colorectal operations by colorectal surgeons at the University of Minnesota in 2008-2009.

Main outcome measures: The primary outcome measure was hospital readmission at 60 days.

Results: The study included 220 patients. Common surgical indications were inflammatory bowel disease (21%), colorectal cancer (39%), and diverticular disease (13%), and 11% were emergencies. Readmissions at 60 days occurred in 25% (n = 54), mostly because of major complications (57%), nonspecific nausea, vomiting and/or pain (18%), dehydration (11%), and wound infections (11%). Predictors of readmission in multivariable analysis were major complications (OR, 13.0), female sex (OR, 5.9), prednisone use (OR, 4.3), BMI ≥30 (OR, 2.6), and preoperative weight loss (OR, 3.4). Age and comorbidity (Charlson score) were not predictors.

Limitations: This was a retrospective study at a single institution, with a small sample size.

Conclusions: Predictors of readmission were major complications and immediate preoperative condition of the patients. Comorbidity profiling does not capture readmission risk. Because most readmissions relate to complications, further efforts to prevent these will improve readmission rates.