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Factors associated with 30-day readmission after restorative proctocolectomy with IPAA: a national study
Jeffrey M Sutton1, Koffi Wima, Gregory C Wilson
1Cincinnati Research on Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
Background:
Hospital readmission has been identified by many payers as a surrogate for surgical quality. The 30-day readmission rate and factors associated with hospital readmission after restorative proctocolectomy with IPAA have not been well studied.
Objective:
The purpose of this work was to identify the rate of and factors associated with hospital readmission within 30 days of restorative proctocolectomy with IPAA.
Design:
A retrospective review of patients undergoing IPAA from 2009 to 2012 in the University HealthSystem Consortium database was performed. Hospitals were stratified into quartiles according to the number of cases performed annually.
Setting:
This study was conducted using a national database of university hospitals.
Patients:
A total of 4952 patients within the 4-year study period were included in the analysis.
Main Outcome Measures:
The primary outcome measured was readmission within 30 days of discharge.
Results:
The 30-day readmission rate was 22.8% overall, although high-volume centers performed significantly better than low-volume centers (high vs low volume: 19.7% vs 28.2%; p < 0.001). When controlling for confounding variables, multivariate analysis identified female sex (OR, 1.191; p = 0.02), government-based (vs private) insurance (OR, 1.364; p < 0.001), and higher preoperative severity of illness (OR, 1.491; p = 0.001) to be associated with readmission. In addition, a significant volume-dependent relationship on 30-day readmission was identified, wherein undergoing operation at the higher-volume hospitals was protective for predicting readmission. Hierarchical regression modeling indicated that 31% of the variation in readmission rates among individual hospitals was accounted for by hospital volume.
Limitations:
This study was limited by its retrospective nature and limited postoperative complication data.
Conclusions:
The national 30-day readmission after IPAA creation was 22.8%, at least double that of other colorectal procedures. This high rate of readmission was mitigated by centers performing the highest volume of cases. Avoidance of referral to centers performing very few of these procedures annually may improve perioperative outcomes and reduce associated morbidity.
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