• Therese G Kerwel, Stefan W Leichtle, Theodor Asgeirsson, Samantha K Hendren, Robert K Cleary, and Martin A Luchtefeld.
• 1Division of Colon and Rectal Surgery, Spectrum Health, Grand Rapids, Michigan 2Department of Surgery, St. Joseph Mercy Health System, Ann Arbor, Michigan 3Department of Surgery, University of Michigan, Ann Arbor, Michigan.
• Dis. Colon Rectum. 2014 Jan 1;57(1):98-104.

BackgroundColon resections are associated with substantial risk for morbidity and readmissions, and these have become markers for quality of care.ObjectiveThe purpose of this study was to determine risk factors for readmissions after elective colectomies to improve patient care and better understand the complex issues associated with readmissions.DesignThis was an analysis of the prospective, statewide, multicenter Michigan Surgical Quality Collaborative database.SettingsThe analysis was conducted at academic and community medical centers in the state of Michigan.PatientsElective laparoscopic and open ileocolic and segmental colectomies from 2008 through 2010 were included.Main Outcome MeasuresUnivariate analysis and a multivariate logistic regression model were used to determine influence of patient characteristics, operative factors, and postoperative complications on the incidence of 30-day postoperative readmission.ResultsThe readmission rate among 4013 cases was 7.3% (N = 293). On the basis of multivariate logistic regression, the top 3 significant risk factors associated with readmission were stroke (OR, 10.0 [95% CI, 2.70-37.0]; p = 0.001), venous thromboembolism (OR, 6.5 [95% CI, 3.7-11.3]; p < 0.0001), and organ-space surgical site infection (OR, 5.6 [95% CI, 3.4-9.4]; p < 0.0001). Important factors that contributed to readmission risk but were not found to be independent predictors of readmission included diabetes mellitus, preoperative steroids, smoking, cardiac comorbidities, age >80 years, anastomotic leaks, fascial dehiscence, sepsis, pneumonia, unplanned intubation, and length of stay.LimitationsThe Michigan Surgical Quality Collaborative is a large database, and true causal relations are difficult to determine; reason for readmission is not recorded in the database.ConclusionsPostoperative complications account for the majority of risk factors behind readmissions after elective colectomy, whereas preoperative risk factors have less direct influence. Current strategies addressing readmission rates should focus on reducing preventable complications.

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