Readmission After Surgical Resection for Colon and Rectal Cancers: A Retrospective Cohort Study

Abstract

Background: Colorectal adenocarcinoma is a leading cause of cancer mortality worldwide, often requiring patients to undergo anatomy-altering surgical interventions leading to increased postoperative readmission. Hospital readmission rates have been correlated with increased mortality. Therefore, it is important to understand the association between 30-day readmission rates and mortality as well as the factors associated with increased readmission rates.

Study design: This is a retrospective review utilizing data from the National Cancer Database. Our primary outcomes of interest were 30- and 90-day mortality rates. Our primary independent variable of interest was 30-day readmission.

Results: Between 2010 and 2016, 207 299 patients underwent surgery for rectal cancer and 754 895 for colon cancer. The readmission rates within 30 days of discharge were 5.4% and 5.5% for patients after surgery for rectal or colon cancer, respectively. 30-day readmission was not associated with 30-day mortality, but it was independently associated with increased 90-day mortality and inferior long-term survival for both cohorts (P = .001). Independent risk factors significantly associated with increased readmission included race, non-private insurance, and low income.

Conclusion: This study provides a large, up-to-date, and comprehensive analysis of readmission rates for colon and rectal cancers. We demonstrate that socioeconomic factors are associated with increased 30-day readmission. 30-day readmission is also independently associated with increased 90-day mortality as well as lower overall survival rates. Our study supports the need for implementation of programs that support patients of lower socioeconomic status undergoing surgery to further decrease readmission rates and mortality.

Keywords: National Cancer Database; colon cancer; rectal cancer; recurrence.

Figure 1.

5-year overall survial (OS) stratified by readmission status. OS was available for 190,142 patients who underwent colon or rectal cancer surgery for adenocarcinoma. 179796 patients were not readmitted within 30 days of surgery and 10346 were readmitted. The mean follow-up for patients who were not readmitted was 6.96 years (CI: 6.935-7.006). Mean follow-up for patients who were readmitted was 4.23 years (CI: 4.126-4.332). The 1-, 3-, and 5-year OS rates for patients not readmitted were 86.5%, 69.95%, and 58.6%. The 1-, 3-, and 5-year OS rates for patients who were readmitted were 75.07%, 57.3%, and 46.2%, P < 0.001.