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Identification of modifiable factors for reducing readmission after colectomy: A national analysis

  • Elise H. Lawson
    Correspondence
    Reprint requests: Elise H. Lawson, MD, MSHS, David Geffen School of Medicine at UCLA, Department of Surgery, 10833 Le Conte Ave. 72-215 CHS, Los Angeles, CA 90095.
    Affiliations
    Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA

    Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

    Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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  • Bruce Lee Hall
    Affiliations
    Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

    Department of Surgery, School of Medicine, Washington University in St Louis and Barnes Jewish Hospital, St Louis, MO

    Center for Health Policy and the Olin Business School at Washington University in St Louis, St Louis, MO

    Department of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, MO
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  • Rachel Louie
    Affiliations
    Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
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  • David S. Zingmond
    Affiliations
    Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
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  • Clifford Y. Ko
    Affiliations
    Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA

    Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

    Veteran's Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
    Search for articles by this author
Published:December 18, 2013DOI:https://doi.org/10.1016/j.surg.2013.12.016

      Background

      Rates of hospital readmission are currently used for public reporting and pay for performance. Colectomy procedures account for a large number of readmissions among operative procedures. Our objective was to compare the importance of 3 groups of clinical variables (demographics, preoperative risk factors, and postoperative complications) in predicting readmission after colectomy procedures.

      Methods

      Patient records (2005–2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Patient demographics (n = 2), preoperative risk factors (n = 23), and 30-day postoperative complications (n = 17) were identified from ACS-NSQIP, whereas 30-day postoperative readmissions and costs were determined from Medicare. Multivariable logistic regression models were used to examine risk-adjusted predictors of colectomy readmission.

      Results

      Among 12,981 colectomy patients, the 30-day postoperative readmission rate was 13.5%. Readmitted patients had slightly greater rates of comorbidities and indicators of clinical severity and substantially greater rates of complications than non-readmitted patients. After risk adjustment, patients with a complication were 3.3 times as likely to be readmitted as patients without a complication. Among individual complications, progressive renal failure and organ-space surgical site infection had the highest risk-adjusted relative risks of readmission (4.6 and 4.0, respectively). Demographic, preoperative risk factor, and postoperative complication variables increased the ability to discriminate readmissions (reflected by the c-statistic) by 5.3%, 23.3%, and 35.4%, respectively.

      Conclusion

      Postoperative complications after colectomy are more predictive of readmission than traditional risk factors. Focusing quality improvement efforts on preventing and managing postoperative complications may be the most important step toward reducing readmission rates.
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