Readmission Rates and Cost Following Colorectal Surgery

BACKGROUND: Hospital readmission is emerging as a quality indicator by the state, federal, and private payors with the goal of denying payment for select readmissions. OBJECTIVE: We designed a study to measure the rate, cost, and risk factors for hospital readmission after colorectal surgery. STUDY DESIGN/SETTING: We reviewed commercial health insurance records of 10, 882 patients who underwent colorectal surgery over a 7-year period (2002-2008). PATIENTS: All patients undergoing colon and/or rectal resection ages 18 to 64 were included. MAIN OUTCOME MEASURE: The 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. RESULTS: Thirty-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). CONCLUSIONS: Readmission 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.