Variation in readmission by hospital after colorectal cancer surgery

IMPORTANCE Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. Readmission has become a major hospital quality metric, but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment.

OBJECTIVE To assess the variability in risk-adjusted readmission rates among hospitals after colorectal surgery.

DESIGN, SETTING, AND PARTICIPANTS We performed a hierarchical multivariable logistic regression analysis of observational data obtained from the Surveillance, Epidemiology, and End Results-Medicare linked database, a nationally representative cancer registry.We studied 44 822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002.

MAIN OUTCOMES AND MEASURES Variation in risk-adjusted 30-day readmission among hospitals.

RESULTS The median age of the study patients was 78 years (interquartile range [IQR], 72-83 years). The overall 30-day readmission rate was 12.3%(n = 5502). Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2%(IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals, with a range of 11.3%to 13.2% (IQR, 12.1%-12.4%). Furthermore, the 95%CI for hospital-specific readmission overlapped the overall mean at every hospital.

CONCLUSIONS AND RELEVANCE Little risk-adjusted variation exists in hospital readmission rates after colorectal surgery. The use of readmission rates as a high-stakes quality measure for payment adjustment or public reporting across surgical specialties should proceed cautiously and must include appropriate risk adjustment.