Table 4.
Summary of Colorectal Surgery Articles
| First author |
n | Data source | Study characteristics | Readmission, % | Mortality of readmitted patients, % |
Top 3 readmission diagnoses |
Significant predictors of readmission on multivariate analysis |
|---|---|---|---|---|---|---|---|
| White (33) | <1000 | Institutional | Patients with Crohn's disease who underwent abdominal surgery between 2002 and 2006 |
8.3% at 30 d | NR | 1. Intra-abdominal abscess 2. Small bowel obstruction 3. Enterocutaneous fistula |
NR |
| Wick (34) | >10,000 | Insurance administrative claims database |
Patient who underwent colon and/or rectal resection between 2002 and 2008 |
11.4% at 30 d 23.3% at 90 d |
NR | 1. Gastrointestinal complication 2. Surgical-site infection related 3. Reoperation |
Surgical-site infection during index admission Proctectomy or colectomy Ostomy created index operation Discharge disposition to nonhome setting Length of stay Severity of illness Admission diagnosis of diverticulitis (vs. colon cancer)* |
| Greenblatt (35) |
>10,000 | SEER Medicare | Patients >65 y old with colon cancer who underwent colectomy between 1992 and 2002 |
11% at 30 d | 7.4% at 1 y for non- readmitted patients 16.3% at 1 y for readmitted patients |
1. Ileus, obstruction, and other gastrointestinal complications 2. Surgical-site infection 3. Pneumonia and other respiratory complications |
Sex Race SEER registry state Hospitalized in year before surgery Hierarchical Condition Categories score Tumor grade Emergent admission Year of surgery Length of stay Blood transfusion Stoma creation In-hospital complication Discharge destination Hospital procedure volume* |
| Schneider (36) |
>10,000 | SEER Medicare | Patients >65 y old with colorectal cancer who underwent colorectal surgery between 1986 and 2005 |
11.2% at 30 d | 52.5% at 3- years for readmitted patients 38.3% at 3- years for non- readmitted patients |
1. Operative complications 2. Dehydration 3. Postoperative infections |
Age Discharge year Length of stay Comorbidity score Postoperative complication Transfusion during index admission Primary rectal procedure Sex* |
| Toneva (37) |
1000– 10,000 |
National Veterans Affairs Surgical Quality Improvement Program |
Patients who underwent elective colorectal resections between 2005 and 2009 |
14.2% at 30 d | NR | NR | Procedure: total colectomy, rectal resection (vs. partial colectomy) Ostomy supplies American Society of Anesthesiologists class Oral antibiotic preparation (vs. no preparation)* |
| Abarca (38) |
<1000 | Institutional | Patients who underwent laparoscopic colectomy between 2004 and 2009 |
12.8% at 30 d | NR | 1. Nausea/vomiting 2. Wound infection 3. Pain (abdominal/rectal) |
NR |
| Faiz (39) | >10,000 | Hospital Episode Statistics database |
Patients who underwent elective colorectal resections for malignancy between 1996 and 2006 |
8.5% at 28 d | NR | NR | Procedure: colorectal resection beyond proximal colonic resection Benign diagnosis Sex Carstairs deprivation score Hospital volume Age* |
| Gu (40) | <1000 | Institutional | Patients who underwent laparoscopic total abdominal colectomy with end ileostomy for severe ulcerative colitis or indeterminate colitis between 1998 and 2010 |
17.2% at 30 d | NR | 1. Small bowel obstruction 1. Distal stump leak 3. Wound infection |
NR |
| Gash (41) | <1000 | Institutional | Patients who underwent laparoscopic colorectal resection with primary anastomosis discharged within 3-days of surgery between 2004 and 2009 |
4% | NR | 1. Anastomotic leak 1. Abscess 1. Ileus |
NR |
| Lidor (42) | >10,000 | Medicare | Patients >65 y old with diverticulitis that underwent left colon resection, colostomy, or ileostomy between 2004 and 2007 |
21.4% at 30 d for initial emergent/urgent surgery 11.9% at 30 d for initial elective surgery 17.2% at 30 d overall |
NR | NR | Emergent/Urgent surgery (vs. elective) Age Comorbidity scale Race |
| Hendren (43) |
>10,000 | Medicare | Patients >65 y old with colon cancer who underwent colectomy between 2003 and 2008 |
15.8% at 30 d | NR | NR | Late discharge Age Gender Race Emergent admission Peptic ulcer disease Paralysis Renal failure Psychoses Congestive heart failure Coagulopathy Diabetes with chronic complications Lymphoma Liver disease Rheumatoid arthritis/collagen vascular disease Myocardial infarction complication Renal failure complication Pulmonary failure complication Thromboembolic event complication Surgical site infection Hemorrhage complication Pneumonia complication Gastrointestinal hemorrhage complication Early discharge* High socioeconomic status* Laparoscopic surgery (vs. open)* |
| Datta (44) | <10000 | Institutional | Patients who underwent ileal pouch-anal anastomosis between 2000 and 2005 |
30.3% at 30 d | NR | 1. Small bowel obstruction 2. Pelvic sepsis / anastomotic leak 3. Dehydration |
Perioperative steroid use |
| Ozturk (45) |
1000– 10,000 |
Institutional | Patients who underwent ileal pouch-anal anastomosis between 1984 and 2008 |
12.0% at 30 d | NR | 1. Ileus, obstruction 2. Dyselectrolytemia 3. Surgical site infection |
Comorbid conditions Laparoscopic technique (vs. open) Synchronous proctocolectomy and ileal pouch–anal anastomosis Postoperative blood transfusion |
| Krpata (46) |
<1000 | Institutional | Patients who underwent laparoscopic or open abdominal colorectal surgery between 2007 and 2011 |
10.4% at 30 d | NR | 1. Ileus/obstruction 2. Anastomotic leak/pelvic collection 2. Surgical site infection 2. intra-abdominal abscess |
NR |
| Nagle (47) | < 1000 | Institutional | Patients who underwent creation of a new permanent or temporary ileostomy in 2011 |
35.4% at 30 d prepathway 21.4% at 30 d postpathway 32.5% at 30 d overall |
NR | 1. Dehydration 2. Infection 3. Small bowel obstruction/ileus |
|
| Messaris (48) |
< 1000 | Institutional | Patients who underwent a colon and/or rectal resection with a diverting ileostomy between 1990 and 2010 |
16.9% at 60 d | NR | 1. Dehydration 2. Infection 3. Gastrointestinal / small bowel obstruction |
Use of perioperative diuretics |
*
Protective against readmission on multivariate analysis.
NR, not reported.