Determinants of 30-day readmission following colectomy: a statewide cohort analysis
Open Access
- Author:
- Kulaylat, Afif N
- Graduate Program:
- Public Health Sciences
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- March 27, 2015
- Committee Members:
- Christopher Hollenbeak, Thesis Advisor/Co-Advisor
Peter W Dillon, Thesis Advisor/Co-Advisor
Kristen H Kjerulff, Thesis Advisor/Co-Advisor - Keywords:
- Readmission
colectomy
PHC4
surgeon volume
comorbidities
complications - Abstract:
- Background. Readmission following colectomy has become an important metric for measuring quality of care. Our aim was to investigate the impact of patient and hospital characteristics on 30-day readmission rates among patients undergoing colectomies in Pennsylvania. Methods. Data were obtained from the Pennsylvania Health Care Cost Containment Council (PHC4), which included all patients undergoing colectomy during 2011 (n=10,155). Characteristics of non-readmitted and readmitted patients were compared with univariate tests. The primary outcome was 30-day readmission, which was modeled using multivariable logistic regression. Results. Of the 10,155 patients who underwent colectomy, 1,492 (14.7%) were readmitted within 30 days of discharge. Readmission was influenced by the underlying diagnosis (P<0.001). Additionally, readmission was more likely with a Charlson Comorbidity Index ≥2 (OR=1.57, P<0.001), emergent admission (OR=1.26, P=0.001), an in-hospital complication (OR=1.46, P<0.001), lowest quartile for surgeon volume (OR=1.24, P<0.001), and construction of an ileostomy (OR=2.31, P<0.001). Factors associated with decreased likelihood of readmission included laparoscopic surgery (OR=0.73, P<0.001). No association with hospital volume was found. Conclusions. 30-day readmission following colectomy is influenced by numerous patient and surgeon-related factors. Reducing in-hospital complications, and improving patient education following ileostomy construction, provide substantial targets for intervention. Our data also suggests that there may be a critical range of colectomies performed annually by surgeons, greater than which, no additional benefit is conferred in reducing readmissions, but below which, there is increased risk of readmission. Further research is needed to determine the influence of laparoscopic surgery in reducing readmission in equally matched patient populations.