Characterising nationwide reasons for unplanned hospital readmission after colorectal cancer surgery.

Autor: Xu W; Department of Surgery, The University of Auckland, Auckland, New Zealand., Wells CI; Department of Surgery, The University of Auckland, Auckland, New Zealand.; Department of General Surgery, Counties Manukau District Health Board, Auckland, New Zealand., McGuinness M; Department of Surgery, The University of Auckland, Auckland, New Zealand.; Department of Surgery, Northland District Health Board, Whangarei, New Zealand., Varghese C; Department of Surgery, The University of Auckland, Auckland, New Zealand., Keane C; Department of Surgery, The University of Auckland, Auckland, New Zealand.; Department of Surgery, Northland District Health Board, Whangarei, New Zealand., Liu C; Department of Surgery, The University of Auckland, Auckland, New Zealand., O'Grady G; Department of Surgery, The University of Auckland, Auckland, New Zealand., Bissett IP; Department of Surgery, The University of Auckland, Auckland, New Zealand.; Department of General Surgery, Auckland City Hospital, Auckland, New Zealand., Harmston C; Department of Surgery, The University of Auckland, Auckland, New Zealand.; Department of Surgery, Northland District Health Board, Whangarei, New Zealand.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2023 May; Vol. 25 (5), pp. 861-871. Date of Electronic Publication: 2023 Jan 11.
DOI: 10.1111/codi.16467
Abstrakt: Background: Readmissions after colorectal cancer surgery are common, despite advancements in surgical care, and have a significant impact on both individual patients and overall healthcare costs. The aim of this study was to determine the 30-and 90 days readmission rate after colorectal cancer surgery, and to investigate the risk factors and clinical reasons for unplanned readmissions.
Method: A multicenter, population-based study including all patients discharged after index colorectal cancer resection from 2010 to 2020 in Aotearoa New Zealand (AoNZ) was completed. The Ministry of Health National Minimum Dataset was used. Rates of readmission at 30 days and 90 days were calculated. Mixed-effect logistic regression models were built to investigate factors associated with unplanned readmission. Reasons for readmission were described.
Results: Data were obtained on 16,885 patients. Unplanned 30-day and 90-day hospital readmission rates were 15.1% and 23.7% respectively. The main readmission risk factors were comorbidities, advanced disease, and postoperative complications. Hospital level variation was not present. Despite risk adjustment, R 2 value of models was low (30 days: 4.3%, 90 days: 5.2%). The most common reasons for readmission were gastrointestinal causes (32.1%) and wound complications (14.4%). Rates of readmission did not improve over the 11 years study period (p = 0.876).
Conclusion: Readmissions following colorectal resections in AoNZ are higher than other comparable healthcare systems and rates have remained constant over time. While patient comorbidities and postoperative complications are associated with readmission, the explanatory value of these variables is poor. To reduce unplanned readmissions, efforts should be focused on prevention and early detection of post-discharge complications.
(© 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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