• Rachelle N Damle, Nicole B Cherng, Julie M Flahive, Jennifer S Davids, Justin A Maykel, Paul R Sturrock, W Brian Sweeney, and Karim Alavi.
• 1Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 2Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts 3Division of Colorectal Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts.
• Dis. Colon Rectum. 2014 Dec 1;57(12):1421-9.

BackgroundAfter 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.ObjectiveThe purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery.DesignAdults 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.SettingsThis study was conducted at an academic hospital and its affiliates.PatientsAdults ≥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 MeasuresReadmission within 30 days of index discharge was the main outcome measured.ResultsA 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.LimitationsFollow-up was limited to 30 days after initial discharge.ConclusionsReadmissions 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.

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