Readmission Risk Following Colorectal Surgery: Impact of Non-home Discharge Disposition
Chau M. Hoang MD1, Jennifer S. Davids MD1, Julie M. Flahive MS2, Paul R. Sturrock MD1, Justin A. Maykel MD1, Karim Alavi MD MPH1
1Division of Colon and Rectal Surgery, UMass Medical School, Worcester, MA, USA; 2Center for Outcomes Research, UMass Medical School, Worcester, MA, USA
Background: Non-home discharge after elective colorectal resection increases readmission risk significantly. However, the risk factors of the different subgroups have not been delineated.
Methods: We identified adults who underwent colorectal resection from 2011-2015 using the University HealthSystem Consortium. Multivariable logistic regression models estimated odds of 30-day readmission.
Results: Of 97,455 patients, 70% were discharged home, 24% home with services, 5% skilled nursing facility (SNF), 1% rehabilitation (rehab) and <1% long-term care hospitals (LTCH). Mean age was 58 years; half were male and 78% were White. Patients with malignant disease, ICU stay, post-operative complications, percutaneous drainage, ileostomy creation, higher severity of illness score, longer length of stay or who were older were more likely to be discharged with service or to facility (p<0.0001). Overall readmission rate was 12%; readmissions among the cohorts were 10% (home), 20% (home with services), 24% (SNF), 53% (rehab) and 28% (LTCH) (p<0.0001). After adjusting for major confounders, discharge to home with services, SNF, or rehab increased risk of readmission by 40% (OR 1.4 (95%CI 1.3-1.4)), 60% (OR 1.6 (95%CI 1.5-1.8)), or 200% (OR 3.0 (95%CI 2.5-3.6), respectively. LTCH discharge did not increase risk (OR 1.1 (95%CI 0.8-1.5)).
Conclusion: Our data suggests that the type of discharge disposition greatly impacts the risk of readmission, and suggests that the care offered through home service, SNF or rehab was inadequate in preventing readmissions for these high-risk patients. 
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