Readmission rates and cost following colorectal surgery

Elizabeth C. Wick, Andrew D. Shore, Kenzo Hirose, Andrew M. Ibrahim, Susan L. Gearhart, Jonathan Efron, Jonathan P. Weiner, Martin A. Makary

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1475-1479
Number of pages5
JournalDiseases of the colon and rectum
Volume54
Issue number12
DOIs
StatePublished - Dec 1 2011

Keywords

  • Colectomy
  • Colorectal
  • Cost
  • Readmission

ASJC Scopus subject areas

  • Gastroenterology

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