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Impact of the “Weekend Effect” for Hospital Discharges on Readmissions After Elective Colectomy

Hoang, Chau M., M.D., M.S.C.I.1; Alavi, Karim, M.D., M.P.H.1; Flahive, Julie M., M.S.2; Sturrock, Paul R., M.D.1; Maykel, Justin A., M.D.1; Davids, Jennifer S., M.D.1

Diseases of the Colon & Rectum: April 2019 - Volume 62 - Issue 4 - p 476–482
doi: 10.1097/DCR.0000000000001272
Original Contributions: Socioeconomic
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BACKGROUND: Hospital readmissions after elective colectomy are costly and potentially preventable. It is unknown whether hospital discharge on a weekend impacts readmission risk.

OBJECTIVE: This study aimed to use a national database to determine whether discharge on a weekend versus weekday impacts the risk of readmission, and to determine what discharge-related factors impact this risk.

DESIGN: This investigation is a retrospective cohort study.

SETTINGS: Data were derived from the University HealthSystem Consortium,

PATIENTS: Adults who underwent elective colectomy from 2011 to 2015 were included.

MAIN OUTCOME MEASURES: The primary outcome measured was the 30-day hospital readmission rate.

RESULTS: Of the 76,031 patients who survived the index hospitalization, the mean age of the study population was 58 years; half were men and more than 75% were white. Overall, 20,829 (27%) were discharged on the weekend, and the remaining 55,202 (73%) were discharged on weekdays. The overall 30-day readmission rate was 10.5%; 8.9% for those discharged on the weekend vs 11.1% for those discharged during the weekday (unadjusted OR, 0.78; 95% CI, 0.74–0.83). The adjusted readmission risk was lower for patients discharged home without services (routine, without organized home health service) on a weekend compared with on a weekday (adjusted OR, 0.87; 95% CI, 0.81–0.93; readmission rates, 7.4% vs 8.9%, p < 0.001); however, the combination of weekend discharge and the need for home services increased readmission risk (adjusted OR, 1.39; 95% CI, 1.25–1.55; readmission rate, 16.2% vs 8.9%, p < 0.001). Although patients discharged to rehabilitation and skilled nursing facilities were at an increased risk of readmission compared with those discharged to home, there was no additive increase in risk of readmission for weekend discharge.

LIMITATIONS: Data did not capture readmission beyond 30 days or to nonindex hospitals.

CONCLUSIONS: Patients discharged on a weekend following elective colectomy were at increased risk of readmission compared with patients discharged on a weekday if they required organized home health services. Further prospective studies are needed to identify areas of intervention to improve the discharge infrastructure. See Video Abstract at http://links.lww.com/DCR/A799.

1 Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

2 Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts

Funding/Support: Chau M. Hoang is a recipient of the Mark Kusek Colorectal Cancer Research Fellowship.

Financial Disclosures: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, WA, June 10 to 13, 2017.

Correspondence: Jennifer S. Davids, M.D., Division of Colon and Rectal Surgery, UMass Memorial Medical Center, 67 Belmont St, Suite 201, Worcester MA 01605. E-mail: Jennifer.Davids@umassmemorial.org.

© 2019 The American Society of Colon and Rectal Surgeons