IMPORTANCE: Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. Readmission has become a major hospital quality metric, but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. OBJECTIVE: To assess the variability in risk-adjusted readmission rates among hospitals after colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS: We performed a hierarchical multivariable logistic regression analysis of observational data obtained from the Surveillance, Epidemiology, and End Results-Medicare linked database, a nationally representative cancer registry. We studied 44,822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002. MAIN OUTCOMES AND MEASURES: Variation in risk-adjusted 30-day readmission among hospitals. RESULTS: The median age of the study patients was 78 years (interquartile range [IQR], 72-83 years). The overall 30-day readmission rate was 12.3% (n = 5502). Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals, with a range of 11.3% to 13.2% (IQR, 12.1%-12.4%). Furthermore, the 95% CI for hospital-specific readmission overlapped the overall mean at every hospital. CONCLUSIONS AND RELEVANCE: Little risk-adjusted variation exists in hospital readmission rates after colorectal surgery. The use of readmission rates as a high-stakes quality measure for payment adjustment or public reporting across surgical specialties should proceed cautiously and must include appropriate risk adjustment.
IMPORTANCE: Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. Readmission has become a major hospital quality metric, but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. OBJECTIVE: To assess the variability in risk-adjusted readmission rates among hospitals after colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS: We performed a hierarchical multivariable logistic regression analysis of observational data obtained from the Surveillance, Epidemiology, and End Results-Medicare linked database, a nationally representative cancer registry. We studied 44,822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002. MAIN OUTCOMES AND MEASURES: Variation in risk-adjusted 30-day readmission among hospitals. RESULTS: The median age of the study patients was 78 years (interquartile range [IQR], 72-83 years). The overall 30-day readmission rate was 12.3% (n = 5502). Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals, with a range of 11.3% to 13.2% (IQR, 12.1%-12.4%). Furthermore, the 95% CI for hospital-specific readmission overlapped the overall mean at every hospital. CONCLUSIONS AND RELEVANCE: Little risk-adjusted variation exists in hospital readmission rates after colorectal surgery. The use of readmission rates as a high-stakes quality measure for payment adjustment or public reporting across surgical specialties should proceed cautiously and must include appropriate risk adjustment.
Authors: Tudor Borza; Bruce L Jacobs; Jeffrey S Montgomery; Alon Z Weizer; Todd M Morgan; Khaled S Hafez; Cheryl T Lee; Benjamin Y Li; Hye Sung Min; Chang He; Scott M Gilbert; Jonathan E Helm; Mariel S Lavieri; Brent K Hollenbeck; Ted A Skolarus Journal: Urology Date: 2017-03-04 Impact factor: 2.649
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Authors: Ryan Howard; Yue S Yin; Lane McCandless; Stewart Wang; Michael Englesbe; David Machado-Aranda Journal: J Am Coll Surg Date: 2018-10-22 Impact factor: 6.113
Authors: David G Brauer; Sarah A Lyons; Matthew R Keller; Matthew G Mutch; Graham A Colditz; Sean C Glasgow Journal: Surgery Date: 2019-01-29 Impact factor: 3.982
Authors: Patrick J Sweigert; Emanuel Eguia; Marshall S Baker; Christina M Link; J Madison Hyer; Anghela Z Paredes; Diamantis I Tsilimigras; Syed Husain; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2020-08-10 Impact factor: 3.452
Authors: Mark A Healy; Scott E Regenbogen; Arielle E Kanters; Pasithorn A Suwanabol; Oliver A Varban; Darrell A Campbell; Justin B Dimick; John C Byrn Journal: JAMA Surg Date: 2017-09-01 Impact factor: 14.766