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27.08.2018 | Ausgabe 4/2019

Surgical Endoscopy 4/2019

Complications after discharge predict readmission after colorectal surgery

Zeitschrift:
Surgical Endoscopy > Ausgabe 4/2019
Autoren:
Jeremy Albright, Farwa Batool, Robert K. Cleary, Andrew J. Mullard, Edward Kreske, Jane Ferraro, Scott E. Regenbogen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00464-018-6398-3) contains supplementary material, which is available to authorized users.
This work was a poster presentation at the American College of Surgeons Clinical Congress, October 22–26, 2017, San Diego, CA.

Abstract

Background

Health care providers, hospitals, and pay-for-performance programs are focused on strategies identifying patients at highest risk for re-admission after colorectal surgery. The study objective was to determine characteristics most associated with re-admission after elective colorectal surgery using a conceptual framework approach.

Methods

This is an observational study of Michigan Surgical Quality Collaborative clinical registry data for 8962 colorectal surgery cases between July-2012 and April-2015. Separate mixed models were fit using known re-admission risk factors aligned in categories that may impact re-admissions by different mechanisms. Overall model discrimination was evaluated using Area Under the Curve estimated on a hold-out data set and examining differences in predicted versus observed re-admission across risk quintiles.

Results

The overall 30-day re-admission rate was 10.5%. From Model 1 to Model 6, discrimination of re-admission was poor until Model 6 (AUC, 0.56, 0.61, 0.65, 0.63, 0.72, 0.81). Differences for observed re-admission rates comparing ‘very low’ versus ‘very high’ risk strata from Model 1 to Model 6 were 6%, 11%, 15%, 14%, 20%, and 30% respectively, and all comparisons were significant (p < 0.01). Though there were significant predictors in the first five models, most were no longer significant when additional predictors were included in subsequent models. Complications identified after discharge significantly increased the likelihood of re-admission and were the strongest predictors.

Conclusion

Statistical models that include complications identified after discharge predict re-admission. Strategies to reduce re-admission after colorectal surgery should emphasize prevention of complications and more effective interventions to manage and ameliorate evolving complications identified after discharge.

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Zusatzmaterial
Supplementary material 1 (DOCX 140 KB)
464_2018_6398_MOESM1_ESM.docx
Literatur
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