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Clinical and Financial Impact of Hospital Readmissions Following Colorectal Resection: Predictors, Outcomes, and Costs: A Thesis
Faculty Advisor
Fred Anderson, PhDAcademic Program
Master of Science in Clinical InvestigationUMass Chan Affiliations
SurgeryDocument Type
Master's ThesisPublication Date
2014-06-25Keywords
Theses, UMMSColorectal Surgery
Cost of Illness
Health Care Costs
Hospital Costs
Hospitalization
Outcome Assessment (Health Care)
Patient Readmission
Colorectal Surgery
Cost of IllnessHealth Care CostsHospital CostsHospitalizationOutcome Assessment (Health Care)Patient ReadmissionGastroenterologyHealth Services ResearchSurgerySurgical Procedures, Operative
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Background: Following passage of the Affordable Care Act in 2010, 30-day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements. We examined the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery (CRS). Methods: The University HealthSystem Consortium database was queried for adults (≥ 18 years) who underwent colorectal resection for cancer, diverticular disease, inflammatory bowel disease, or benign tumors between January 2008 and December 2011. Our outcomes of interest were readmission within 30-days of the patient’s index discharge, hospital readmission outcomes, and total direct hospital costs. Results: A total of 70,484 patients survived the index hospitalization after CRS during the years under study, 13.7% (9,632) of which were readmitted within 30 days of discharge. The strongest independent predictors of readmission were: LOS ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.53; 95% CI 1.45-1.61), and discharge to skilled nursing (OR 1.63; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.54-3.40). Of those readmitted, half occurred within 7 days of the index admission, 13% required ICU care, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was over twice as high ($26,917 v. $13,817) for readmitted than for nonreadmitted patients. Conclusions: Readmissions following colorectal resection occur frequently and incur a significant financial burden on the healthcare system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating healthcare costs. Categorization: Outcomes research; Cost analysis; Colon and Rectal SurgeryDOI
10.13028/M25P5GPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32100Rights
Copyright is held by the author, with all rights reserved.Scopus Count
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