Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e31822ff8f0
Original Contribution

Readmission Rates and Cost Following Colorectal Surgery

Wick, Elizabeth C. M.D.1; Shore, Andrew D. Ph.D.1; Hirose, Kenzo M.D.1; Ibrahim, Andrew M. B.A.1; Gearhart, Susan L. M.D.1; Efron, Jonathan M.D.1; Weiner, Jonathan P. Dr.P.H.2; Makary, Martin A. M.D., M.P.H.1,2

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BACKGROUND: Hospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions.

OBJECTIVE: We designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery.

STUDY DESIGN/SETTING: We reviewed commercial health insurance records of 10,882 patients who underwent colorectal surgery over a 7-year period (2002–2008).

PATIENTS: All patients undergoing colon and/or rectal resection ages 18 to 64 were included.

MAIN OUTCOME MEASURE: The 30-day and 90-day readmission rates, the number of readmissions per patient, the median cost, length of stay, and risk factors for readmission were analyzed.

RESULTS: Thirty-day readmission occurred in 11.4% (1239/10,882) of patients. Readmission between 31 and 90 days occurred in an additional 11.9% (1027/10,882) of patients for a total 90-day readmission rate of 23.3%. Two or more readmissions occurred in 1.4% (155) and 5.2% (570) of patients in the first 30 and 90 days. Mean readmission length of stay was 8 days, and the median cost per stay was $8885. Initial hospitalization risk factors for readmission were the diagnosis of a surgical site infection (OR 1.2), creation of a stoma (OR 1.2), discharge to nursing home (OR 1.2), index admission length of stay >7 days (OR 1.2), proctectomy (OR 1.1), and severity of illness score (severity of illness 3 = OR 1.1; severity of illness 4 = OR 1.3).

CONCLUSIONS: Readmission after colorectal surgery occurs frequently and is associated with a cost of approximately $9000 per readmission. Nationwide these findings account for $300 million in readmission costs annually for colorectal surgery alone. Clinical and systems-based prevention strategies are needed to reduce readmission.

© The ASCRS 2011


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