Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors.

Abstract

Colon resections are associated with substantial risk for morbidity and readmissions, and these have become markers for quality of care. The purpose of this study was to determine risk factors for readmissions after elective colectomies to improve patient care and better understand the complex issues associated with readmissions. This was an analysis of the prospective, statewide, multicenter Michigan Surgical Quality Collaborative database. The analysis was conducted at academic and community medical centers in the state of Michigan. Elective laparoscopic and open ileocolic and segmental colectomies from 2008 through 2010 were included. Univariate analysis and a multivariate logistic regression model were used to determine influence of patient characteristics, operative factors, and postoperative complications on the incidence of 30-day postoperative readmission. The readmission rate among 4013 cases was 7.3% (N = 293). On the basis of multivariate logistic regression, the top 3 significant risk factors associated with readmission were stroke (OR, 10.0 [95% CI, 2.70-37.0]; p = 0.001), venous thromboembolism (OR, 6.5 [95% CI, 3.7-11.3]; p < 0.0001), and organ-space surgical site infection (OR, 5.6 [95% CI, 3.4-9.4]; p < 0.0001). Important factors that contributed to readmission risk but were not found to be independent predictors of readmission included diabetes mellitus, preoperative steroids, smoking, cardiac comorbidities, age >80 years, anastomotic leaks, fascial dehiscence, sepsis, pneumonia, unplanned intubation, and length of stay. The Michigan Surgical Quality Collaborative is a large database, and true causal relations are difficult to determine; reason for readmission is not recorded in the database. 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.