Diseases of the colon and rectum
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Multicenter Study
Acute health care resource utilization for ileostomy patients is higher than expected.
Patients requiring an ileostomy following colorectal surgery are at risk for increased health-care utilization after discharge. Prior studies evaluating postoperative ileostomy care may underestimate health-care utilization by reporting only "same-institution" readmission rates. ⋯ Patients undergoing colorectal surgery with an ileostomy return to the hospital after discharge twice as frequently as those with a primary anastomosis or colostomy, often to hospitals other than the primary institution. As postdischarge health-care utilization becomes a measured quality metric, it is increasingly important to help these patients to safely transition to home.
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Multicenter Study
Factors associated with 30-day readmission after restorative proctocolectomy with IPAA: a national study.
Hospital readmission has been identified by many payers as a surrogate for surgical quality. The 30-day readmission rate and factors associated with hospital readmission after restorative proctocolectomy with IPAA have not been well studied. ⋯ The national 30-day readmission after IPAA creation was 22.8%, at least double that of other colorectal procedures. This high rate of readmission was mitigated by centers performing the highest volume of cases. Avoidance of referral to centers performing very few of these procedures annually may improve perioperative outcomes and reduce associated morbidity.
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Randomized Controlled Trial Multicenter Study
Evaluation of long-term anorectal function after low anterior resection: a 5-year follow-up of a randomized multicenter trial.
Anorectal function after rectal surgery with low anastomosis is often impaired. Outcome of long-term anorectal function is poorly understood but may improve over time. ⋯ Anorectal function was impaired for many patients, but the temporary presence of a defunctioning stoma after rectal resection did not affect long-term outcome. Anorectal function did not change between 1-year and 5-year follow-up.
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Multicenter Study
Complication rates of ostomy surgery are high and vary significantly between hospitals.
Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. ⋯ Morbidity and mortality rates for modern ostomy surgery are high. Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an opportunity to identify quality improvement practices that could be disseminated among hospitals.
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Multicenter Study
Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors.
Colon resections are associated with substantial risk for morbidity and readmissions, and these have become markers for quality of care. ⋯ Postoperative 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.