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.
1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2 Department of Health Policy and Management, Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland
Funding/Support: The data set used in the present study was originally created for a different research project on patterns of obesity care within selected BlueCross BlueShield (BCBS) plans, which was supported by unrestricted research grants from Ethicon Endo-Surgery, Inc (a Johnson & Johnson company), Pfizer, Inc, and GlaxoSmithKline. The data and in-kind database development support and guidance were provided by the BCBS Obesity Care Collaborative, which consists of the following organizations affiliated with the BCBS Health Services Research Alliance: BCBS Association, BCBS of Tennessee, BCBS of Hawaii, BCBS of Michigan, BCBS of North Carolina, Highmark, Inc, of Pennsylvania, Independence Blue Cross of Pennsylvania, Wellmark BCBS of Iowa, and Wellmark BCBS of South Dakota.
Presented at the meeting of The American Society of Colorectal Surgeons, Vancouver, British Columbia, Canada, May 14 to 18, 2011.
Correspondence: Elizabeth C. Wick, M.D., Department of Surgery, Johns Hopkins University School of Medicine, Blalock 658, 600 N. Wolfe St, Baltimore, MD 21287. E-mail: email@example.com