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Background: Discharge to nonhome settings after colorectal resection may increase risk of hospital readmission., Objective: The purpose of this study was to determine the impact of various discharge dispositions on 30-day readmission after adjusting for confounding demographic and clinical factors., Design: This was a retrospective cohort study., Settings: Data were obtained from the University HealthSystem Consortium (2011-2015)., Patients: Adults who underwent elective colorectal resection were included., Main Outcome Measures: Thirty-day hospital readmission risk was measured., Results: The mean age of the study population (n = 97,455) was 58 years; half were men and 78% were white. Seventy percent were discharged home routinely (home without service), 24% to home with organized health services, 5% to skilled nursing facility, 1% to rehabilitation facility, and <1% to long-term care hospital. Overall rate of readmission was 12%; 9% from home without service, 16% from home with organized home health services, 19% from skilled nursing facility, 34% from rehabilitation facility, and 22% from long-term care hospital (p < 0.001). Patients with an intensive care unit stay, more postoperative complications, and longer hospitalization stay were more likely to be discharged to home with organized home health services or to a facility (p < 0.001). Discharge to home with organized home health services, skilled nursing facility, or rehabilitation facility increased multivariable-adjusted readmission risk by 30% (OR = 1.3 (95% CI, 1.3-1.6)), 60% (OR = 1.6 (95% CI, 1.5-1.8)), or 200% (OR = 3.0 (95% CI, 2.5-3.6)). Discharge to long-term care hospital was not associated with higher adjusted readmission risk (OR = 1.2 (95% CI, 0.9-1.6)), despite this group having the highest comorbidity and postoperative complications. Among patients readmitted within 30 days, median time to readmission was significantly different among home without service (n = 7), home with organized home health services (n = 8), skilled nursing facility (n = 8), rehabilitation facility (n = 9), and long-term care hospital (n = 12; p < 0.001)., Limitations: This study was limited by its retrospective nature., Conclusions: Discharge to home with organized home health services, skilled nursing facility, or rehabilitation facility, but not long-term care hospital, is associated with increased adjusted risk of readmission compared with routine home discharge. Potential targets to decrease readmission include improving transition of care at discharge, improving quality of care after discharge, and improving facility resources. See Video Abstract at http://links.lww.com/DCR/B272., No Todas Las Configuraciones De Alta Son Iguales: RIESGOS DE READMISIÓN A 30 DÍAS DESPUÉS DE CIRUGÍA COLORRECTAL ELECTIVA: El alta hospitalaria hacia el domicilio luego de una resección colorrectal puede aumentar el riesgo de readmisión.Determinar el impacto de varias configuraciones diferentes de alta en la readmisión a 30 días luego de ajustar factores demográficos y clínicos.Estudio de cohortes retrospectivo.Los datos se obtuvieron del Consorcio del Sistema de Salud Universitaria (2011-2015).Todos aquellos adultos que se sometieron a una resección colorrectal electiva.Los riesgos de readmisión hospitalaria a 30 días.La edad media de la población estudiada (n = 97,455) fué de 58 años; la mitad eran hombres y un 78% eran blancos. El 70% fueron dados de alta de manera rutinaria (a domicilio sin servicios complementarios), 24% alta a domicilio con servicios de salud organizados, 5% alta hacia un centro con cuidados de enfermería especializada, 1% alta hacia un centro de rehabilitación y <1% alta hacia un hospital con atención a largo plazo. La tasa global de readmisión fué del 12%; nueve por ciento desde domicilios sin servicios complementarios, 16% desde domicilios con servicios de salud organizados, 19% desde un centro de enfermería especializada, 34% desde el centro de rehabilitación y 22% desde un hospital con atención a largo plazo (p <0.001). Los pacientes con estadías en Unidad de Cuidados Intensivos, con más complicaciones postoperatorias y con una hospitalización prolongada tenían más probabilidades de ser dados de alta hacia un domicilio con servicios de salud organizados o hacia un centro de rehabilitación (p <0,001). El alta hospitalaria con servicios organizados de atención médica domiciliaria, centros de enfermería especializada o centros de rehabilitación aumentaron el riesgo de readmisión ajustada de múltiples variables en un 30% (OR 1.3, IC 95% 1.3-1.6), 60% (OR 1.6, IC 95% 1.5-1.8), o 200% (OR 3.0, IC 95% 2.5-3.6), respectivamente. El alta hospitalaria a largo plazo no fué asociada con un mayor riesgo de readmisión ajustada (OR 1.2, IC 95% 0.9-1.6), no obstante que este grupo fué el que tuvo las mayores comorbilidades y complicaciones postoperatorias. Entre los pacientes readmitidos dentro de los 30 días, la mediana del tiempo hasta el reingreso fue significativamente diferente entre el domicilio sin servicios complementarios (7), domicilio con servicios de salud organizados (8), el centro de cuidados de enfermería especializada (8), centros de rehabilitación (9) y hospitales con atención a largo plazo (12) (p <0,001).Naturaleza retrospectiva del presente estudio.El alta hospitalaria con servicios de salud domiciliarios organizados, hacia centros de enfermería especializada o hacia centros de rehabilitación se asocian con un mayor riesgo ajustado de readmisión en comparación con el alta domiciliaria de rutina y los hospitales con atención a largo plazo. Los objetivos potenciales para disminuir la readmisión incluyen mejorar la transición de la atención al momento del alta, mejorar la calidad de la atención después del alta y mejorar las diferentes facilidades para los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B272.

Background: Hospital readmissions after elective colectomy are costly and potentially preventable. It is unknown whether hospital discharge on a weekend impacts readmission risk., Objective: This study aimed to use a national database to determine whether discharge on a weekend versus weekday impacts the risk of readmission, and to determine what discharge-related factors impact this risk., Design: This investigation is a retrospective cohort study., Settings: Data were derived from the University HealthSystem Consortium, PATIENTS:: Adults who underwent elective colectomy from 2011 to 2015 were included., Main Outcome Measures: The primary outcome measured was the 30-day hospital readmission rate., Results: Of the 76,031 patients who survived the index hospitalization, the mean age of the study population was 58 years; half were men and more than 75% were white. Overall, 20,829 (27%) were discharged on the weekend, and the remaining 55,202 (73%) were discharged on weekdays. The overall 30-day readmission rate was 10.5%; 8.9% for those discharged on the weekend vs 11.1% for those discharged during the weekday (unadjusted OR, 0.78; 95% CI, 0.74-0.83). The adjusted readmission risk was lower for patients discharged home without services (routine, without organized home health service) on a weekend compared with on a weekday (adjusted OR, 0.87; 95% CI, 0.81-0.93; readmission rates, 7.4% vs 8.9%, p < 0.001); however, the combination of weekend discharge and the need for home services increased readmission risk (adjusted OR, 1.39; 95% CI, 1.25-1.55; readmission rate, 16.2% vs 8.9%, p < 0.001). Although patients discharged to rehabilitation and skilled nursing facilities were at an increased risk of readmission compared with those discharged to home, there was no additive increase in risk of readmission for weekend discharge., Limitations: Data did not capture readmission beyond 30 days or to nonindex hospitals., Conclusions: Patients discharged on a weekend following elective colectomy were at increased risk of readmission compared with patients discharged on a weekday if they required organized home health services. Further prospective studies are needed to identify areas of intervention to improve the discharge infrastructure. See Video Abstract at http://links.lww.com/DCR/A799.

Background: Racial disparities in outcomes are well described among surgical patients., Objective: The purpose of this work was to identify any racial disparities in the receipt of a minimally invasive approach for colorectal surgery., Design: Adults undergoing colorectal surgery were studied using the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify predictors for the receipt of a minimally invasive approach., Settings: The study was conducted at academic hospitals and their affiliates., Patients: Adults ≥18 years of age who underwent surgery for colorectal cancer, diverticular disease, IBD, or benign colorectal tumor between 2008 and 2011 were included., Main Outcome Measures: The receipt of a minimally invasive surgical approach was the main measured outcome., Results: A total of 82,474 adult patients met the study inclusion criteria. Of these, 69,664 (84%) were white, 10,874 (13%) were black, and 1936 (2%) were Asian. Blacks were younger, with higher rates of public insurance and higher comorbidity burden and baseline severity of illness compared with white and Asian patients. Black patients were less likely (adjusted OR = 0.83 (95% CI, 0.79-0.87)) and Asian patients more likely (adjusted OR = 1.34 (95% CI, 1.21-1.49)) than whites to receive minimally invasive surgery. This association did not change with stratification by insurance type (public or private). Black patients had higher rates of intensive care unit admission and nonhome discharge, as well as an increased length of stay compared with white and Asian patients. No differences in complications, readmission, or mortality rates were observed with minimally invasive surgery, but black patients were more likely to be readmitted or to die with open surgery., Limitations: The study was limited by the retrospective nature of its data., Conclusions: We identified racial differences in the receipt of a minimally invasive approach for colorectal surgery, regardless of insurance status, as well as improved outcomes for minority races who underwent a minimally invasive technique compared with open surgery. The improved outcomes associated with minimally invasive surgery should prompt efforts to increase rates of its use among black patients.

Background: After passage of the Affordable Care Act, 30 -day hospital readmissions have come under greater scrutiny. Excess readmissions for certain medical conditions and procedures now result in penalizations on all Medicare reimbursements., Objective: The purpose of this work was to define the risk factors, outcomes, and costs of 30-day readmissions after colorectal surgery., Design: Adults undergoing colorectal surgery were studied using data from the University HealthSystem Consortium. Univariate and multivariable analyses were used to identify patient-related risk factors for, and 30-day outcomes of, readmission after colorectal surgery., Settings: This study was conducted at an academic hospital and its affiliates., Patients: Adults ≥18 years of age who underwent colorectal surgery for cancer, diverticular disease, IBD, or benign tumors between 2008 and 2011 were included in this study., Main Outcome Measures: Readmission within 30 days of index discharge was the main outcome measured., Results: A total of 70,484 patients survived the index hospitalization after colorectal surgery; 9632 (13.7%) were readmitted within 30 days of discharge. The strongest independent predictors of readmission were length of stay ≥4 days (OR 1.44; 95% CI 1.32-1.57), stoma (OR 1.54; 95% CI 1.46-1.51), and discharge to skilled nursing (OR 1.62; 95% CI 1.49-1.76) or rehabilitation facility (OR 2.93; 95% CI 2.53-3.40). Of those readmitted, half of the readmissions occurred within 7 days, 13% required the intensive care unit, 6% had a reoperation, and 2% died during the readmission stay. The median combined total direct hospital cost was more than 2 times higher ($26,917 vs $13,817; p < 0.001) for readmitted than for nonreadmitted patients., Limitations: Follow-up was limited to 30 days after initial discharge., Conclusions: Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.