Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort

Sonia T. Orcutt, Linda T. Li, Courtney J. Balentine, Daniel Albo, Samir S. Awad, David H. Berger, Daniel A. Anaya

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Readmissions following colorectal surgery are common. However, there are limited data examining unplanned readmissions (URs) after colorectal cancer (CRC) surgery. The goal of this study was to identify reasons and predictors of UR, and to examine their clinical impact on CRC patients. Methods A retrospective cohort study using a prospective CRC surgery database of patients treated at a VA tertiary referral center was performed (2005-2011). Ninety-day URs were recorded and classified based on reason for readmission. Clinical impact of UR was measured using a validated classification for postoperative complications. Multivariate logistic regression analyses were performed to identify predictors of UR. Results 487 patients were included; 104 (21%) required UR. Although the majority of UR were due to surgical reasons (n = 72, 69%), medical complications contributed to 25% of all readmission events. Nearly half of UR (n = 44, 40%) had significant clinical implications requiring invasive interventions, intensive care unit stays, or led to death. After multivariate logistic regression, the following independent predictors of UR were identified: African-American race (odds ratio [OR] 0.47 [0.27-0.88]), ostomy creation (OR 2.50 [1.33-4.70]), and any postoperative complication (OR 4.36 [2.48-7.68]). Conclusions Ninety-day URs following colorectal cancer surgery are common, and represent serious events associated with worse outcomes. In addition to postoperative complications, surgical details that can be anticipated (i.e., ileostomy creation) and medical events unrelated to surgery, both contribute as important and potentially preventable reasons for UR. Future studies should focus on developing and examining interventions focused at improving the process of perioperative care for this high-risk population.

Original languageEnglish (US)
Pages (from-to)370-377
Number of pages8
JournalJournal of Surgical Research
Volume201
Issue number2
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Colorectal Surgery
Veterans
Colorectal Neoplasms
Odds Ratio
Logistic Models
Ostomy
Perioperative Care
Ileostomy
Tertiary Care Centers
African Americans
Intensive Care Units
Cohort Studies
Retrospective Studies
Regression Analysis
Databases
Population

Keywords

  • Colorectal cancer surgery
  • Health care delivery
  • Hospital readmissions
  • Outcomes research

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Orcutt, S. T., Li, L. T., Balentine, C. J., Albo, D., Awad, S. S., Berger, D. H., & Anaya, D. A. (2016). Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort. Journal of Surgical Research, 201(2), 370-377. https://doi.org/10.1016/j.jss.2015.11.026

Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort. / Orcutt, Sonia T.; Li, Linda T.; Balentine, Courtney J.; Albo, Daniel; Awad, Samir S.; Berger, David H.; Anaya, Daniel A.

In: Journal of Surgical Research, Vol. 201, No. 2, 01.04.2016, p. 370-377.

Research output: Contribution to journalArticle

Orcutt, ST, Li, LT, Balentine, CJ, Albo, D, Awad, SS, Berger, DH & Anaya, DA 2016, 'Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort', Journal of Surgical Research, vol. 201, no. 2, pp. 370-377. https://doi.org/10.1016/j.jss.2015.11.026
Orcutt, Sonia T. ; Li, Linda T. ; Balentine, Courtney J. ; Albo, Daniel ; Awad, Samir S. ; Berger, David H. ; Anaya, Daniel A. / Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort. In: Journal of Surgical Research. 2016 ; Vol. 201, No. 2. pp. 370-377.
@article{9524b1e318e0400dba923fb24fee78ef,
title = "Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort",
abstract = "Background Readmissions following colorectal surgery are common. However, there are limited data examining unplanned readmissions (URs) after colorectal cancer (CRC) surgery. The goal of this study was to identify reasons and predictors of UR, and to examine their clinical impact on CRC patients. Methods A retrospective cohort study using a prospective CRC surgery database of patients treated at a VA tertiary referral center was performed (2005-2011). Ninety-day URs were recorded and classified based on reason for readmission. Clinical impact of UR was measured using a validated classification for postoperative complications. Multivariate logistic regression analyses were performed to identify predictors of UR. Results 487 patients were included; 104 (21{\%}) required UR. Although the majority of UR were due to surgical reasons (n = 72, 69{\%}), medical complications contributed to 25{\%} of all readmission events. Nearly half of UR (n = 44, 40{\%}) had significant clinical implications requiring invasive interventions, intensive care unit stays, or led to death. After multivariate logistic regression, the following independent predictors of UR were identified: African-American race (odds ratio [OR] 0.47 [0.27-0.88]), ostomy creation (OR 2.50 [1.33-4.70]), and any postoperative complication (OR 4.36 [2.48-7.68]). Conclusions Ninety-day URs following colorectal cancer surgery are common, and represent serious events associated with worse outcomes. In addition to postoperative complications, surgical details that can be anticipated (i.e., ileostomy creation) and medical events unrelated to surgery, both contribute as important and potentially preventable reasons for UR. Future studies should focus on developing and examining interventions focused at improving the process of perioperative care for this high-risk population.",
keywords = "Colorectal cancer surgery, Health care delivery, Hospital readmissions, Outcomes research",
author = "Orcutt, {Sonia T.} and Li, {Linda T.} and Balentine, {Courtney J.} and Daniel Albo and Awad, {Samir S.} and Berger, {David H.} and Anaya, {Daniel A.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.jss.2015.11.026",
language = "English (US)",
volume = "201",
pages = "370--377",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort

AU - Orcutt, Sonia T.

AU - Li, Linda T.

AU - Balentine, Courtney J.

AU - Albo, Daniel

AU - Awad, Samir S.

AU - Berger, David H.

AU - Anaya, Daniel A.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background Readmissions following colorectal surgery are common. However, there are limited data examining unplanned readmissions (URs) after colorectal cancer (CRC) surgery. The goal of this study was to identify reasons and predictors of UR, and to examine their clinical impact on CRC patients. Methods A retrospective cohort study using a prospective CRC surgery database of patients treated at a VA tertiary referral center was performed (2005-2011). Ninety-day URs were recorded and classified based on reason for readmission. Clinical impact of UR was measured using a validated classification for postoperative complications. Multivariate logistic regression analyses were performed to identify predictors of UR. Results 487 patients were included; 104 (21%) required UR. Although the majority of UR were due to surgical reasons (n = 72, 69%), medical complications contributed to 25% of all readmission events. Nearly half of UR (n = 44, 40%) had significant clinical implications requiring invasive interventions, intensive care unit stays, or led to death. After multivariate logistic regression, the following independent predictors of UR were identified: African-American race (odds ratio [OR] 0.47 [0.27-0.88]), ostomy creation (OR 2.50 [1.33-4.70]), and any postoperative complication (OR 4.36 [2.48-7.68]). Conclusions Ninety-day URs following colorectal cancer surgery are common, and represent serious events associated with worse outcomes. In addition to postoperative complications, surgical details that can be anticipated (i.e., ileostomy creation) and medical events unrelated to surgery, both contribute as important and potentially preventable reasons for UR. Future studies should focus on developing and examining interventions focused at improving the process of perioperative care for this high-risk population.

AB - Background Readmissions following colorectal surgery are common. However, there are limited data examining unplanned readmissions (URs) after colorectal cancer (CRC) surgery. The goal of this study was to identify reasons and predictors of UR, and to examine their clinical impact on CRC patients. Methods A retrospective cohort study using a prospective CRC surgery database of patients treated at a VA tertiary referral center was performed (2005-2011). Ninety-day URs were recorded and classified based on reason for readmission. Clinical impact of UR was measured using a validated classification for postoperative complications. Multivariate logistic regression analyses were performed to identify predictors of UR. Results 487 patients were included; 104 (21%) required UR. Although the majority of UR were due to surgical reasons (n = 72, 69%), medical complications contributed to 25% of all readmission events. Nearly half of UR (n = 44, 40%) had significant clinical implications requiring invasive interventions, intensive care unit stays, or led to death. After multivariate logistic regression, the following independent predictors of UR were identified: African-American race (odds ratio [OR] 0.47 [0.27-0.88]), ostomy creation (OR 2.50 [1.33-4.70]), and any postoperative complication (OR 4.36 [2.48-7.68]). Conclusions Ninety-day URs following colorectal cancer surgery are common, and represent serious events associated with worse outcomes. In addition to postoperative complications, surgical details that can be anticipated (i.e., ileostomy creation) and medical events unrelated to surgery, both contribute as important and potentially preventable reasons for UR. Future studies should focus on developing and examining interventions focused at improving the process of perioperative care for this high-risk population.

KW - Colorectal cancer surgery

KW - Health care delivery

KW - Hospital readmissions

KW - Outcomes research

UR - http://www.scopus.com/inward/record.url?scp=84961180372&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961180372&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2015.11.026

DO - 10.1016/j.jss.2015.11.026

M3 - Article

C2 - 27020821

AN - SCOPUS:84961180372

VL - 201

SP - 370

EP - 377

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -