Decreasing readmissions by focusing on complications and underlying reasons - 20/03/18
Abstract |
Background |
To analyze demographics and outcomes of patients focusing on 30-day readmission status and identify procedure-specific risk factors.
Methods |
Patients undergoing abdominal colorectal surgery (2011–2013) were identified Demographics and outcomes including in-hospital complications were compared based on readmission status.
Results |
A total of 6637 patients were identified with a mean age of 51.2(±17.1) years. Seven hundred and seventy five(11.7%) patients were readmitted at least once within 30-day. The most common index procedures related to readmission were stoma closure (n = 127/775, 16.4%) and total colectomy (n = 105/775, 13.6%). Readmitted patients had longer length of index hospital stay (LOS)(8.2 ± 5.9 vs 7.9 ± 6.9 days,p < 0.001) and operative time(167 ± 104 vs 144 ± 95 min, p < 0.001), higher intraoperative(2% vs 1%,p = 0.04) and in-hospital complication rates(36% vs 28%,p < 0.001). Main reasons for readmissions were gastrointestinal-related causes(n = 222, 29%), small bowel obstruction (n = 133,17%), wound-related complications(n = 108,14%), and dehydration(n = 93,12%). Median readmission LOS was 4(1–71)days and 54%(n = 407) of readmissions occurred within 7 days of discharge.
Conclusion |
Increased postoperative complications may be the main preventable underlying reason for increased risk of hospital readmission after colorectal surgery. Preventive measures to decrease complications and actions to identify high risk patients for complications would help to reduce readmissions.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Our study revealed that the overall 30-day unplanned readmission rate after colorectal surgery in a high volume tertiary care center is 11.7%. |
• | Presence of pulmonary comorbidity, preoperative steroid use, perioperative transfusion, type of surgical procedure. |
• | Majority of readmissions are managed medically and majority of patients are readmitted within 7 days after discharge. |
• | Main reasons for readmissions were gastrointestinal-related causes (29%), small bowel obstruction (17%), wound-related complications (14%), and dehydration (12%). |
• | Increased postoperative complications is the main preventable underlying reason for higher readmission rates after colorectal surgery. |
• | Majority of unplanned readmissions does not require surgical management and are treated with medical and supportive treatment. |
Keywords : Unplanned readmission, Colorectal surgery, Predictive factors
Plan
Vol 215 - N° 4
P. 557-562 - avril 2018 Retour au numéro
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