• Elizabeth C Wick, Andrew D Shore, Kenzo Hirose, Andrew M Ibrahim, Susan L Gearhart, Jonathan Efron, Jonathan P Weiner, and Martin A Makary.
• Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. ewick1@jhmi.edu
• Dis. Colon Rectum. 2011 Dec 1;54(12):1475-9.

BackgroundHospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions.ObjectiveWe designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery.Study Design/SettingWe reviewed commercial health insurance records of 10,882 patients who underwent colorectal surgery over a 7-year period (2002-2008).PatientsAll patients undergoing colon and/or rectal resection ages 18 to 64 were included.Main Outcome MeasureThe 30-day and 90-day readmission rates, the number of readmissions per patient, the median cost, length of stay, and risk factors for readmission were analyzed.ResultsThirty-day readmission occurred in 11.4% (1239/10,882) of patients. Readmission between 31 and 90 days occurred in an additional 11.9% (1027/10,882) of patients for a total 90-day readmission rate of 23.3%. Two or more readmissions occurred in 1.4% (155) and 5.2% (570) of patients in the first 30 and 90 days. Mean readmission length of stay was 8 days, and the median cost per stay was $8885. Initial hospitalization risk factors for readmission were the diagnosis of a surgical site infection (OR 1.2), creation of a stoma (OR 1.2), discharge to nursing home (OR 1.2), index admission length of stay >7 days (OR 1.2), proctectomy (OR 1.1), and severity of illness score (severity of illness 3 = OR 1.1; severity of illness 4 = OR 1.3).ConclusionsReadmission after colorectal surgery occurs frequently and is associated with a cost of approximately $9000 per readmission. Nationwide these findings account for $300 million in readmission costs annually for colorectal surgery alone. Clinical and systems-based prevention strategies are needed to reduce readmission.

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