Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs
dc.contributor.advisor | Karim Alavi, MD/Surgery | |
dc.contributor.author | Damle, Rachelle N. | |
dc.contributor.author | Cherng, Nicole B. | |
dc.contributor.author | Flahive, Julie | |
dc.contributor.author | Davids, Jennifer S. | |
dc.contributor.author | Maykel, Justin A. | |
dc.contributor.author | Sturrock, Paul R. | |
dc.contributor.author | Sweeney, W. Brian | |
dc.contributor.author | Alavi, Karim | |
dc.date | 2022-08-11T08:10:55.000 | |
dc.date.accessioned | 2022-08-23T17:24:52Z | |
dc.date.available | 2022-08-23T17:24:52Z | |
dc.date.issued | 2014-12-01 | |
dc.date.submitted | 2016-04-20 | |
dc.identifier.citation | Dis Colon Rectum. 2014 Dec;57(12):1421-9. doi: 10.1097/DCR.0000000000000251. <a href="http://dx.doi.org/10.1097/DCR.0000000000000251">Link to article on publisher's site</a> | |
dc.identifier.issn | 0012-3706 (Linking) | |
dc.identifier.doi | 10.1097/DCR.0000000000000251 | |
dc.identifier.pmid | 25380009 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/49282 | |
dc.description | <p>Nichole Cherng participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.</p> | |
dc.description.abstract | BACKGROUND: After passage of the Affordable Care Act, 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. OBJECTIVE: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery. DESIGN: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery. SETTINGS: This study was conducted at an academic hospital and its affiliates. PATIENTS: Adults > /=18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study. MAIN OUTCOME MEASURES: Readmission within 30 days of index discharge was the main outcome measured. RESULTS: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay > /=4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients. LIMITATIONS: Follow-up was limited to 30 days after initial discharge. CONCLUSIONS: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs. | |
dc.language.iso | en_US | |
dc.relation | <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=25380009&dopt=Abstract">Link to Article in PubMed</a> | |
dc.relation.url | http://dx.doi.org/10.1097/DCR.0000000000000251 | |
dc.subject | Cohort Studies | |
dc.subject | *Colectomy | |
dc.subject | Comorbidity | |
dc.subject | Cost of Illness | |
dc.subject | Female | |
dc.subject | Hospital Costs | |
dc.subject | Humans | |
dc.subject | *Intestinal Diseases | |
dc.subject | Length of Stay | |
dc.subject | Male | |
dc.subject | Middle Aged | |
dc.subject | Outcome Assessment (Health Care) | |
dc.subject | Patient Discharge | |
dc.subject | *Patient Readmission | |
dc.subject | *Postoperative Complications | |
dc.subject | Reoperation | |
dc.subject | Risk Factors | |
dc.subject | Severity of Illness Index | |
dc.subject | Time Factors | |
dc.subject | United States | |
dc.subject | Clinical Epidemiology | |
dc.subject | Health Services Research | |
dc.subject | Surgery | |
dc.title | Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs | |
dc.type | Journal Article | |
dc.source.journaltitle | Diseases of the colon and rectum | |
dc.source.volume | 57 | |
dc.source.issue | 12 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/ssp/225 | |
dc.identifier.contextkey | 8497977 | |
html.description.abstract | <p>BACKGROUND: After passage of the Affordable Care Act, 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.</p> <p>OBJECTIVE: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.</p> <p>DESIGN: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery.</p> <p>SETTINGS: This study was conducted at an academic hospital and its affiliates.</p> <p>PATIENTS: Adults > /=18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study.</p> <p>MAIN OUTCOME MEASURES: Readmission within 30 days of index discharge was the main outcome measured.</p> <p>RESULTS: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay > /=4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients.</p> <p>LIMITATIONS: Follow-up was limited to 30 days after initial discharge.</p> <p>CONCLUSIONS: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.</p> | |
dc.identifier.submissionpath | ssp/225 | |
dc.contributor.department | Department of Surgery | |
dc.contributor.department | School of Medicine | |
dc.contributor.department | Senior Scholars Program | |
dc.source.pages | 1421-9 | |
dc.contributor.student | Nicole Cherng |