Multivariable analysis of factors associated with hospital readmission after intestinal surgery

Yehuda Kariv, Wei Wang, Anthony J. Senagore, Jeffrey P. Hammel, Victor W. Fazio, Conor P. Delaney

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Background: Readmission rates after major abdominal surgery have a significant impact on hospital costs and quality of care. Identification of risk factors for readmission may improve postoperative care and discharge plans. Methods: One hundred fifty consecutive patients readmitted within 30 days of discharge after intestinal surgery (RD) were compared with matched nonreadmitted patients. Patient-related (demographic, comorbidity, medications), disease-related (diagnosis, type of surgery), and perioperative course variables were collected for logistic regression analysis. Results: RD was associated with chronic obstructive pulmonary disease (odds ratio [OR] 7.12 and 95% confidence interval [CI] 1.4-37.6), worse functional capacity class (OR 2.02 and CI 1.15-3.56), previous anticoagulant therapy (OR 4.85 and CI 1.2-19.7), steroid treatment, and discharge to a facility other than home (OR 4.35 and CI 0.97-20.0, P = .055). In patients with intestinal perforation, RD rate was decreased (OR 0.3 and CI 0.1-0.9), but this was associated with a longer primary hospital stay (median 8 vs. 6 days, P = .12). RD causes included surgical site septic complications (33%), ileus and/or small-bowel obstruction (23%), medical complications (24%), and others (20%). Conclusions: Functional capacity, chronic obstructive pulmonary disease, previous anticoagulant therapy, perioperative steroids, and discharge destination are independent predictors of RD. Disease-related factors have minor impact on RD rates. Improving functional status before surgery, decreasing the adverse impact of steroids, and/or stratifying perioperative anticoagulant use may decrease unexpected readmissions in this patient population.

Original languageEnglish (US)
Pages (from-to)364-371
Number of pages8
JournalAmerican Journal of Surgery
Volume191
Issue number3
DOIs
StatePublished - Mar 2006
Externally publishedYes

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Patient Readmission
Statistical Factor Analysis
Odds Ratio
Confidence Intervals
Anticoagulants
Steroids
Chronic Obstructive Pulmonary Disease
Intestinal Perforation
Ileus
Postoperative Care
Hospital Costs
Quality of Health Care
Comorbidity
Length of Stay
Therapeutics
Logistic Models
Regression Analysis
Demography
Population

Keywords

  • Colorectal surgery
  • Postoperative care
  • Readmission
  • Risk factors

ASJC Scopus subject areas

  • Surgery

Cite this

Kariv, Y., Wang, W., Senagore, A. J., Hammel, J. P., Fazio, V. W., & Delaney, C. P. (2006). Multivariable analysis of factors associated with hospital readmission after intestinal surgery. American Journal of Surgery, 191(3), 364-371. https://doi.org/10.1016/j.amjsurg.2005.10.038

Multivariable analysis of factors associated with hospital readmission after intestinal surgery. / Kariv, Yehuda; Wang, Wei; Senagore, Anthony J.; Hammel, Jeffrey P.; Fazio, Victor W.; Delaney, Conor P.

In: American Journal of Surgery, Vol. 191, No. 3, 03.2006, p. 364-371.

Research output: Contribution to journalArticle

Kariv, Yehuda ; Wang, Wei ; Senagore, Anthony J. ; Hammel, Jeffrey P. ; Fazio, Victor W. ; Delaney, Conor P. / Multivariable analysis of factors associated with hospital readmission after intestinal surgery. In: American Journal of Surgery. 2006 ; Vol. 191, No. 3. pp. 364-371.
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abstract = "Background: Readmission rates after major abdominal surgery have a significant impact on hospital costs and quality of care. Identification of risk factors for readmission may improve postoperative care and discharge plans. Methods: One hundred fifty consecutive patients readmitted within 30 days of discharge after intestinal surgery (RD) were compared with matched nonreadmitted patients. Patient-related (demographic, comorbidity, medications), disease-related (diagnosis, type of surgery), and perioperative course variables were collected for logistic regression analysis. Results: RD was associated with chronic obstructive pulmonary disease (odds ratio [OR] 7.12 and 95{\%} confidence interval [CI] 1.4-37.6), worse functional capacity class (OR 2.02 and CI 1.15-3.56), previous anticoagulant therapy (OR 4.85 and CI 1.2-19.7), steroid treatment, and discharge to a facility other than home (OR 4.35 and CI 0.97-20.0, P = .055). In patients with intestinal perforation, RD rate was decreased (OR 0.3 and CI 0.1-0.9), but this was associated with a longer primary hospital stay (median 8 vs. 6 days, P = .12). RD causes included surgical site septic complications (33{\%}), ileus and/or small-bowel obstruction (23{\%}), medical complications (24{\%}), and others (20{\%}). Conclusions: Functional capacity, chronic obstructive pulmonary disease, previous anticoagulant therapy, perioperative steroids, and discharge destination are independent predictors of RD. Disease-related factors have minor impact on RD rates. Improving functional status before surgery, decreasing the adverse impact of steroids, and/or stratifying perioperative anticoagulant use may decrease unexpected readmissions in this patient population.",
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N2 - Background: Readmission rates after major abdominal surgery have a significant impact on hospital costs and quality of care. Identification of risk factors for readmission may improve postoperative care and discharge plans. Methods: One hundred fifty consecutive patients readmitted within 30 days of discharge after intestinal surgery (RD) were compared with matched nonreadmitted patients. Patient-related (demographic, comorbidity, medications), disease-related (diagnosis, type of surgery), and perioperative course variables were collected for logistic regression analysis. Results: RD was associated with chronic obstructive pulmonary disease (odds ratio [OR] 7.12 and 95% confidence interval [CI] 1.4-37.6), worse functional capacity class (OR 2.02 and CI 1.15-3.56), previous anticoagulant therapy (OR 4.85 and CI 1.2-19.7), steroid treatment, and discharge to a facility other than home (OR 4.35 and CI 0.97-20.0, P = .055). In patients with intestinal perforation, RD rate was decreased (OR 0.3 and CI 0.1-0.9), but this was associated with a longer primary hospital stay (median 8 vs. 6 days, P = .12). RD causes included surgical site septic complications (33%), ileus and/or small-bowel obstruction (23%), medical complications (24%), and others (20%). Conclusions: Functional capacity, chronic obstructive pulmonary disease, previous anticoagulant therapy, perioperative steroids, and discharge destination are independent predictors of RD. Disease-related factors have minor impact on RD rates. Improving functional status before surgery, decreasing the adverse impact of steroids, and/or stratifying perioperative anticoagulant use may decrease unexpected readmissions in this patient population.

AB - Background: Readmission rates after major abdominal surgery have a significant impact on hospital costs and quality of care. Identification of risk factors for readmission may improve postoperative care and discharge plans. Methods: One hundred fifty consecutive patients readmitted within 30 days of discharge after intestinal surgery (RD) were compared with matched nonreadmitted patients. Patient-related (demographic, comorbidity, medications), disease-related (diagnosis, type of surgery), and perioperative course variables were collected for logistic regression analysis. Results: RD was associated with chronic obstructive pulmonary disease (odds ratio [OR] 7.12 and 95% confidence interval [CI] 1.4-37.6), worse functional capacity class (OR 2.02 and CI 1.15-3.56), previous anticoagulant therapy (OR 4.85 and CI 1.2-19.7), steroid treatment, and discharge to a facility other than home (OR 4.35 and CI 0.97-20.0, P = .055). In patients with intestinal perforation, RD rate was decreased (OR 0.3 and CI 0.1-0.9), but this was associated with a longer primary hospital stay (median 8 vs. 6 days, P = .12). RD causes included surgical site septic complications (33%), ileus and/or small-bowel obstruction (23%), medical complications (24%), and others (20%). Conclusions: Functional capacity, chronic obstructive pulmonary disease, previous anticoagulant therapy, perioperative steroids, and discharge destination are independent predictors of RD. Disease-related factors have minor impact on RD rates. Improving functional status before surgery, decreasing the adverse impact of steroids, and/or stratifying perioperative anticoagulant use may decrease unexpected readmissions in this patient population.

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