BACKGROUND: Clinical care pathways reduce postoperative stay after major bowel operations. Concerns about unexpected early readmissions and delays in diagnosis of complications remain unanswered. The objectives of this study were determination of readmission rate and outcomes for patients undergoing intestinal operations. STUDY DESIGN: Patients readmitted (PR) within 30 days of discharge after intestinal operations were compared with patients who were not readmitted (NR). Variables that might predict readmission were evaluated. RESULTS: Of 553 patients, 56 (10.1%) were readmitted after 10 days (interquartile range [IQR] 4.5 to 15.5 days). PR and NR groups had similar age, gender, diagnosis, preoperative comorbidities, and index operations. Discharge hemoglobin level, white cell count, antibiotic use, or presence of stoma did not affect readmission. PR had a greater frequency of steroid use (p = 0.03) during index admission. Median length of stay for the index hospitalization was 5 days (IQR 4 to 8 days) for the NR and 6 days (IQR 4.8 to 9 days) for the PR group (p = 0.049). Duration of readmission was 4 days (IQR 2 to 9 days) in the PR group, with equal total median length of stay identical for PR and NR patients with complications (median 12 days). Clinical outcomes for PR patients and NR patients with complications were similar. CONCLUSIONS: Early readmission is an unpredictable sequel of major bowel operations; it does not correlate with shorter hospital stay. Identification of unpredictable complications after discharge that require later invasive intervention does not adversely affect clinical outcomes. Readmission within 30 days of a patient who has attained standardized discharge criteria may not be a valid indicator of poor quality of care.
BACKGROUND: Clinical care pathways reduce postoperative stay after major bowel operations. Concerns about unexpected early readmissions and delays in diagnosis of complications remain unanswered. The objectives of this study were determination of readmission rate and outcomes for patients undergoing intestinal operations. STUDY DESIGN:Patients readmitted (PR) within 30 days of discharge after intestinal operations were compared with patients who were not readmitted (NR). Variables that might predict readmission were evaluated. RESULTS: Of 553 patients, 56 (10.1%) were readmitted after 10 days (interquartile range [IQR] 4.5 to 15.5 days). PR and NR groups had similar age, gender, diagnosis, preoperative comorbidities, and index operations. Discharge hemoglobin level, white cell count, antibiotic use, or presence of stoma did not affect readmission. PR had a greater frequency of steroid use (p = 0.03) during index admission. Median length of stay for the index hospitalization was 5 days (IQR 4 to 8 days) for the NR and 6 days (IQR 4.8 to 9 days) for the PR group (p = 0.049). Duration of readmission was 4 days (IQR 2 to 9 days) in the PR group, with equal total median length of stay identical for PR and NR patients with complications (median 12 days). Clinical outcomes for PRpatients and NR patients with complications were similar. CONCLUSIONS: Early readmission is an unpredictable sequel of major bowel operations; it does not correlate with shorter hospital stay. Identification of unpredictable complications after discharge that require later invasive intervention does not adversely affect clinical outcomes. Readmission within 30 days of a patient who has attained standardized discharge criteria may not be a valid indicator of poor quality of care.
Authors: P A Baltodano; Y Webb-Vargas; K C Soares; C W Hicks; C M Cooney; P Cornell; K K Burce; T M Pawlik; F E Eckhauser Journal: Hernia Date: 2015-08-19 Impact factor: 4.739
Authors: Donald J Lucas; Adil Haider; Elliot Haut; Rebecca Dodson; Christopher L Wolfgang; Nita Ahuja; John Sweeney; Timothy M Pawlik Journal: Ann Surg Date: 2013-09 Impact factor: 12.969
Authors: Bobby Tingstedt; László Nehéz; Jakob Axelsson; Björn Lindman; Roland Andersson Journal: Int J Colorectal Dis Date: 2005-11-03 Impact factor: 2.571
Authors: Sophia Y Chen; Miloslawa Stem; Susan L Gearhart; Bashar Safar; Sandy H Fang; Nilofer S Azad; Adrian G Murphy; Amol K Narang; Christopher L Wolfgang; Jonathan E Efron Journal: World J Surg Date: 2019-10 Impact factor: 3.352
Authors: Deborah S Keller; Blake Bankwitz; Donya Woconish; Bradley J Champagne; Harry L Reynolds; Sharon L Stein; Conor P Delaney Journal: Surg Endosc Date: 2013-08-27 Impact factor: 4.584
Authors: John Saunders; Garth H Ballantyne; Scott Belsley; Daniel J Stephens; Amit Trivedi; Douglas R Ewing; Vincent A Iannace; Rafael F Capella; Annette Wasileweski; Steven Moran; Hans J Schmidt Journal: Obes Surg Date: 2008-05-02 Impact factor: 4.129