Readmissions within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements

Fabian Grass, Jacopo Crippa, Jenna K. Lovely, James Ansell, Kevin T. Behm, Pietro Achilli, Martin Hübner, Scott R. Kelley, Kellie L. Mathis, Eric J. Dozois, David W. Larson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Hospital readmission rate is an important quality metric and has been recognized as a key measure of hospital value-based purchasing programs. OBJECTIVE: This study aimed to assess the risk factors for hospital readmission with a focus on potentially preventable early readmissions within 48 hours of discharge. DESIGN: This is a retrospective cohort study. SETTINGS: This study was conducted at a tertiary academic facility with a standardized enhanced recovery pathway. PATIENTS: Consecutive patients undergoing elective major colorectal resections between 2011 and 2016 were included. MAIN OUTCOME MEASURES: Univariable and multivariable risk factors for overall and early (<48 hours) readmissions were identified. Specific surgical and medical reasons for readmission were compared between early and late readmissions. RESULTS: In total, 526 of 4204 patients (12.5%) were readmitted within 30 days of discharge. Independent risk factors were ASA score (≥3; OR, 1.5; 95% CI, 1.1-2), excess perioperative weight gain (OR, 1.7; 95% CI, 1.3-2.3), ileostomy (OR, 1.4; 95% CI, 1-2), and transfusion (OR, 2; 95% CI, 1.4-3), or reoperation (OR, 11.4; 95% CI, 7.4-17.5) during the index stay. No potentially preventable risk factor for early readmission (128 patients, 24.3% of all readmissions, 3% of total cohort) was identified, and index hospital stay of ≤3 days was not associated with increased readmission (OR, 0.9; 95% CI, 0.7-1.2). Although ileus and small-bowel obstruction (early: 43.8% vs late: 15.5%, p < 0.001) were leading causes for early readmissions, deep infections (3.9% vs 16.3%, p < 0.001) and acute kidney injury (0% vs 5%, p = 0.006) were mainly observed during readmissions after 48 hours. LIMITATIONS: Risk of underreporting due to loss of follow-up and the potential co-occurrence of complications were limitations of this study. CONCLUSIONS: Early hospital readmission was mainly due to ileus or bowel obstruction, whereas late readmissions were related to deep infections and acute kidney injury. A suspicious attitude toward potential ileus-related symptoms before discharge and dedicated education for ostomy patients are important. A short index hospital stay was not associated with increased readmission rates. See Video Abstract at http://links.lww.com/DCR/B237.

Original languageEnglish (US)
Pages (from-to)1142-1150
Number of pages9
JournalDiseases of the colon and rectum
DOIs
StateAccepted/In press - 2020

Keywords

  • Colorectal
  • Enhanced recovery
  • Prevention
  • Readmission

ASJC Scopus subject areas

  • Gastroenterology

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    Grass, F., Crippa, J., Lovely, J. K., Ansell, J., Behm, K. T., Achilli, P., Hübner, M., Kelley, S. R., Mathis, K. L., Dozois, E. J., & Larson, D. W. (Accepted/In press). Readmissions within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements. Diseases of the colon and rectum, 1142-1150. https://doi.org/10.1097/DCR.0000000000001652