Abstract
Background
Unplanned 30-day readmission is common after major surgery, including rectal cancer
surgery. The present study aimed to assess the rate and predictors of unplanned 30-day
readmission after proctectomy for rectal cancer.
Methods
This was a retrospective case-control study using data from the National Cancer Database.
Patients with non-metastatic rectal cancer who underwent proctectomy were included,
and patients who required readmission within 30 days after discharge were compared
to patients who were not readmitted in regard to patient and treatment baseline factors
to determine the predictors of 30-day readmission after proctectomy. The main outcome
measures were the rate and predictors of 30-day unplanned readmission and the impact
of readmission on short-term mortality and overall survival.
Results
A total of 55,181 patients (60.9% men) with a mean age of 61.2 years were included.
The 30-day readmission rate was 7.07% (95% confidence interval: 6.9–7.3). A Charlson
score of 0 (odds ratio: 0.75, P < .001), Medicare insurance (odds ratio: 0.836, P = .04), and private insurance (odds ratio: 0.73, P = .0003) were predictive of a lower likelihood of 30-day readmission, whereas urban
living area (odds ratio: 1.18, P = .01), rural living area (odds ratio: 1.65%, P = .0004), neoadjuvant radiation therapy (odds ratio: 1.37, P = .001), pull-through coloanal anastomosis (odds ratio: 1.37, P = .0005), conversion to open surgery (odds ratio: 1.25, P = .001), and hospital stay ≥6 days (odds ratio: 1.02, P < .001) were predictive of a higher likelihood of 30-day readmission. Readmitted
patients had a higher rate of 90-day mortality (3.1% vs 2.1%, P < .001) and a lower 5-year overall survival (67.0% vs 72.7%, P < .001) than non-readmitted patients. Using the weighted ORs of the significant predictors
of 30-day readmission, a risk score, the Cleveland Clinic Florida REadmission afTer sUrgery for Rectal caNcer in 30 days (RETURN-30) score, was developed.
Conclusion
Comorbidities, residence in urban or rural areas, neoadjuvant radiation therapy, pull-through
coloanal anastomosis, conversion to open surgery, and extended hospital stay were
predictive of a higher risk of 30-day readmission. Patients who were readmitted had
a higher rate of 90-day mortality and a lower 5-year overall survival.
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Article info
Publication history
Published online: December 03, 2022
Accepted:
October 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
