Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients
Abstract Background To evaluate readmissions to determine predictors and patterns of readmission. Methods Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. Results A total of 212 read...
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| Veröffentlicht in: | The American journal of surgery 2014-03, Vol.207 (3), p.346-351 |
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| creator | Keller, Deborah S., M.S., M.D Swendseid, Brian, B.S Khorgami, Zhamak, M.D Champagne, Bradley J., M.D Reynolds, Harry L., M.D Stein, Sharon L., M.D Delaney, Conor P., M.D., M.Ch., Ph.D |
| description | Abstract Background To evaluate readmissions to determine predictors and patterns of readmission. Methods Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. Results A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older ( P = .003), had more comorbidities ( P < .0001), longer operative times ( P < .0001), length of stay ( P < .0001), and higher costs ( P = .002). At the time of discharge, more readmitted patients required temporary nursing ( P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time ( P = .05) and LOS were longer ( P = .028), and more patients required temporary nursing care at the time of discharge ( P = .046). Readmissions caused an additional mean hospital cost of $12,670.89. Conclusions Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group. |
| doi_str_mv | 10.1016/j.amjsurg.2013.09.008 |
| format | Article |
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Methods Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. Results A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older ( P = .003), had more comorbidities ( P < .0001), longer operative times ( P < .0001), length of stay ( P < .0001), and higher costs ( P = .002). At the time of discharge, more readmitted patients required temporary nursing ( P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time ( P = .05) and LOS were longer ( P = .028), and more patients required temporary nursing care at the time of discharge ( P = .046). Readmissions caused an additional mean hospital cost of $12,670.89. Conclusions Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2013.09.008</identifier><identifier>PMID: 24439160</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Adult ; Aged ; Anal Canal - surgery ; Body mass index ; Cancer ; Colon - surgery ; Colonic Diseases - epidemiology ; Colonic Diseases - surgery ; Colorectal surgery ; Comorbidity ; Confidence intervals ; Constipation ; Databases, Factual ; Enhanced recovery pathways ; Female ; Healthcare outcomes ; Healthcare utilization ; Hospital costs ; Humans ; Inflammatory bowel disease ; Intensive care ; Male ; Medical personnel ; Medical records ; Middle Aged ; Ohio ; Ostomy ; Patient Readmission - statistics & numerical data ; Readmissions ; Rectal Diseases - epidemiology ; Rectal Diseases - surgery ; Rectum - surgery ; Regression analysis ; Retrospective Studies ; Surgery ; Tumors</subject><ispartof>The American journal of surgery, 2014-03, Vol.207 (3), p.346-351</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-7552b12839cf82195e6e8b1505ef838962ad39e16d21d3af293b5f0782bc0803</citedby><cites>FETCH-LOGICAL-c448t-7552b12839cf82195e6e8b1505ef838962ad39e16d21d3af293b5f0782bc0803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002961013006922$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24439160$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keller, Deborah S., M.S., M.D</creatorcontrib><creatorcontrib>Swendseid, Brian, B.S</creatorcontrib><creatorcontrib>Khorgami, Zhamak, M.D</creatorcontrib><creatorcontrib>Champagne, Bradley J., M.D</creatorcontrib><creatorcontrib>Reynolds, Harry L., M.D</creatorcontrib><creatorcontrib>Stein, Sharon L., M.D</creatorcontrib><creatorcontrib>Delaney, Conor P., M.D., M.Ch., Ph.D</creatorcontrib><title>Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Abstract Background To evaluate readmissions to determine predictors and patterns of readmission. Methods Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. Results A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older ( P = .003), had more comorbidities ( P < .0001), longer operative times ( P < .0001), length of stay ( P < .0001), and higher costs ( P = .002). At the time of discharge, more readmitted patients required temporary nursing ( P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time ( P = .05) and LOS were longer ( P = .028), and more patients required temporary nursing care at the time of discharge ( P = .046). Readmissions caused an additional mean hospital cost of $12,670.89. Conclusions Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Aged</subject><subject>Anal Canal - surgery</subject><subject>Body mass index</subject><subject>Cancer</subject><subject>Colon - surgery</subject><subject>Colonic Diseases - epidemiology</subject><subject>Colonic Diseases - surgery</subject><subject>Colorectal surgery</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Constipation</subject><subject>Databases, Factual</subject><subject>Enhanced recovery pathways</subject><subject>Female</subject><subject>Healthcare outcomes</subject><subject>Healthcare utilization</subject><subject>Hospital costs</subject><subject>Humans</subject><subject>Inflammatory bowel disease</subject><subject>Intensive care</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Ohio</subject><subject>Ostomy</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Readmissions</subject><subject>Rectal Diseases - epidemiology</subject><subject>Rectal Diseases - surgery</subject><subject>Rectum - surgery</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Tumors</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkktv1TAQhS1ERW8LPwEUiQ2bhBk7D5sFFaooIFVqpXZvOc6kOOSFnVS6_x5H9_JQN6ws298cj88Zxl4jZAhYvu8yM3Rh9Q8ZBxQZqAxAPmM7lJVKUUrxnO0AgKeqRDhlZyF0cYuYixfslOe5UFjCjjW3nhpnFzc-JMt3StZxPhyYuqcPiZ2G2fjt0pNpBrcs1CSP5MMaknEa039O7dRPnmJhn2xtkd8ns1kcjUt4yU5a0wd6dVzP2f3V5_vLr-n1zZdvl5-uU5vnckmrouA1cimUbSVHVVBJssYCCmqlkKrkphGKsGw4NsK0XIm6aKGSvLYgQZyzdwfZ2U8_VwqLHlyw1PdmpGkNOirlmMsKq4i-fYJ20-rH2FykRC5EgbyMVHGgrJ9C8NTq2bvB-L1G0FsKutPHFPSWggalYwqx7s1Rfa0Hav5U_bY9AhcHgKIbj468DjY6ZaPzm4W6mdx_n_j4RMH2bnTW9D9oT-Hvb3TgGvTdNgrbJKAAKBXn4hcMn7Ct</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Keller, Deborah S., M.S., M.D</creator><creator>Swendseid, Brian, B.S</creator><creator>Khorgami, Zhamak, M.D</creator><creator>Champagne, Bradley J., M.D</creator><creator>Reynolds, Harry L., M.D</creator><creator>Stein, Sharon L., M.D</creator><creator>Delaney, Conor P., M.D., M.Ch., Ph.D</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140301</creationdate><title>Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients</title><author>Keller, Deborah S., M.S., M.D ; Swendseid, Brian, B.S ; Khorgami, Zhamak, M.D ; Champagne, Bradley J., M.D ; Reynolds, Harry L., M.D ; Stein, Sharon L., M.D ; Delaney, Conor P., M.D., M.Ch., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-7552b12839cf82195e6e8b1505ef838962ad39e16d21d3af293b5f0782bc0803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Aged</topic><topic>Anal Canal - surgery</topic><topic>Body mass index</topic><topic>Cancer</topic><topic>Colon - surgery</topic><topic>Colonic Diseases - epidemiology</topic><topic>Colonic Diseases - surgery</topic><topic>Colorectal surgery</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Constipation</topic><topic>Databases, Factual</topic><topic>Enhanced recovery pathways</topic><topic>Female</topic><topic>Healthcare outcomes</topic><topic>Healthcare utilization</topic><topic>Hospital costs</topic><topic>Humans</topic><topic>Inflammatory bowel disease</topic><topic>Intensive care</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medical records</topic><topic>Middle Aged</topic><topic>Ohio</topic><topic>Ostomy</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Readmissions</topic><topic>Rectal Diseases - epidemiology</topic><topic>Rectal Diseases - surgery</topic><topic>Rectum - surgery</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keller, Deborah S., M.S., M.D</creatorcontrib><creatorcontrib>Swendseid, Brian, B.S</creatorcontrib><creatorcontrib>Khorgami, Zhamak, M.D</creatorcontrib><creatorcontrib>Champagne, Bradley J., M.D</creatorcontrib><creatorcontrib>Reynolds, Harry L., M.D</creatorcontrib><creatorcontrib>Stein, Sharon L., M.D</creatorcontrib><creatorcontrib>Delaney, Conor P., M.D., M.Ch., Ph.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keller, Deborah S., M.S., M.D</au><au>Swendseid, Brian, B.S</au><au>Khorgami, Zhamak, M.D</au><au>Champagne, Bradley J., M.D</au><au>Reynolds, Harry L., M.D</au><au>Stein, Sharon L., M.D</au><au>Delaney, Conor P., M.D., M.Ch., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>207</volume><issue>3</issue><spage>346</spage><epage>351</epage><pages>346-351</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Abstract Background To evaluate readmissions to determine predictors and patterns of readmission. Methods Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. Results A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older ( P = .003), had more comorbidities ( P < .0001), longer operative times ( P < .0001), length of stay ( P < .0001), and higher costs ( P = .002). At the time of discharge, more readmitted patients required temporary nursing ( P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time ( P = .05) and LOS were longer ( P = .028), and more patients required temporary nursing care at the time of discharge ( P = .046). Readmissions caused an additional mean hospital cost of $12,670.89. Conclusions Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24439160</pmid><doi>10.1016/j.amjsurg.2013.09.008</doi><tpages>6</tpages></addata></record> |
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| subjects | Abdomen Adult Aged Anal Canal - surgery Body mass index Cancer Colon - surgery Colonic Diseases - epidemiology Colonic Diseases - surgery Colorectal surgery Comorbidity Confidence intervals Constipation Databases, Factual Enhanced recovery pathways Female Healthcare outcomes Healthcare utilization Hospital costs Humans Inflammatory bowel disease Intensive care Male Medical personnel Medical records Middle Aged Ohio Ostomy Patient Readmission - statistics & numerical data Readmissions Rectal Diseases - epidemiology Rectal Diseases - surgery Rectum - surgery Regression analysis Retrospective Studies Surgery Tumors |
| title | Predicting the unpredictable: comparing readmitted versus non-readmitted colorectal surgery patients |
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