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Predictors of Readmission Following Proctectomy for Rectal Cancer

O’Connell, Emer P. M.B. M.Ch., M.R.C.S.I.1; Healy, Vincent M.B. B.Ch., B.A.O.(Hons.), M.Ch.(Hons.), L.R.C.P., L.R.C.S.I.1; Fitzpatrick, Fidelma M.D.2,3; Higgins, Caitriona A. B.Sc., Pg.Dip.1; Burke, John P. Ph.D., F.R.C.S.I.1,3; McNamara, Deborah A. M.D., F.R.C.S.I.(Gen.)1,3

Diseases of the Colon & Rectum: June 2019 - Volume 62 - Issue 6 - p 703–710
doi: 10.1097/DCR.0000000000001355
Original Contributions: Colorectal Cancer
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BACKGROUND: Unplanned readmission after surgery negatively impacts surgical recovery. Few studies have sought to define predictors of readmission in a rectal cancer cohort alone. Readmission following rectal cancer surgery may be reduced by the identification and modification of factors associated with readmission.

OBJECTIVES: This study seeks to characterize the predictors of 30-day readmission following proctectomy for rectal cancer.

DESIGN: This study is a retrospective analysis of prospectively gathered cohort data. Outcomes were compared between readmitted and nonreadmitted patients. Multivariate analysis of factors association with readmission was performed by using binary logistic regression.

SETTINGS: This study was conducted at Beaumont Hospital, a nationally designated, publicly funded cancer center.

PATIENTS: Two hundred forty-six consecutive patients who underwent proctectomy for rectal cancer between January 2012 and December 2015 were selected.

MAIN OUTCOME MEASURES: The primary outcomes measured were readmission within 30 days of discharge and the variables associated with readmission, categorized into patient factors, perioperative factors, and postoperative factors.

RESULTS: Thirty-one (12.6%) patients were readmitted within 30 days of discharge following index rectal resection. The occurrence of anastomotic leaks, high-output stoma, and surgical site infections was significantly associated with readmission within 30 days (anastomotic leak OR 3.60, p = 0.02; high-output stoma OR 11.04, p = 0.003; surgical site infections OR 13.39, p = 0.01). Surgical site infections and high-output stoma maintained significant association on multivariate analysis (surgical site infections OR 10.02, p = 0.001; high-output stoma OR 9.40, p = 0.02). No significant difference was noted in the median length of stay or frequency of prolonged admissions (greater than 24 days) between readmitted and nonreadmitted patients.

LIMITATIONS: The institutional database omits a number of socioeconomic factors and comorbidities that may influence readmission, limiting our capacity to analyze the relative contribution of these factors to our findings.

CONCLUSIONS: An early postoperative care bundle to detect postoperative complications could prevent some unnecessary inpatient admissions following proctectomy. Key constituents should include early identification and management of stoma-related complications and surgical site infection. See Video Abstract at http://links.lww.com/DCR/A912.

1 Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland

2 Department of Microbiology, Beaumont Hospital, Dublin, Ireland

3 Royal College of Surgeons in Ireland, Dublin, Ireland

Funding/Support: None reported.

Financial Disclosure: None reported.

Emer P. O’Connell and Vincent Healy are joint first authors.

Correspondence: Emer P. O’Connell, M.B. M.Ch., M.R.C.S.I., c/o Suite 18 BPC, Beaumont Hospital, Beaumont Rd, Dublin 9, Ireland. E-mail: emer.oconnell@umail.ucc.ie.

© 2019 The American Society of Colon and Rectal Surgeons