Readmissions Within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements.

Abstract

BACKGROUND:

Hospital readmission rate is an important quality metric and has been recognized as a key measure of hospital value-based purchasing programs.

OBJECTIVE:

This study aimed to assess the risk factors for hospital readmission with a focus on potentially preventable early readmissions within 48 hours of discharge.

DESIGN:

This is a retrospective cohort study.

SETTINGS:

This study was conducted at a tertiary academic facility with a standardized enhanced recovery pathway.

PATIENTS:

Consecutive patients undergoing elective major colorectal resections between 2011 and 2016 were included.

MAIN OUTCOME MEASURES:

Univariable and multivariable risk factors for overall and early (<48 hours) readmissions were identified. Specific surgical and medical reasons for readmission were compared between early and late readmissions.

RESULTS:

In total, 526 of 4204 patients (12.5%) were readmitted within 30 days of discharge. Independent risk factors were ASA score (≥3; OR, 1.5; 95% CI, 1.1-2), excess perioperative weight gain (OR, 1.7; 95% CI, 1.3-2.3), ileostomy (OR, 1.4; 95% CI, 1-2), and transfusion (OR, 2; 95% CI, 1.4-3), or reoperation (OR, 11.4; 95% CI, 7.4-17.5) during the index stay. No potentially preventable risk factor for early readmission (128 patients, 24.3% of all readmissions, 3% of total cohort) was identified, and index hospital stay of ≤3 days was not associated with increased readmission (OR, 0.9; 95% CI, 0.7-1.2). Although ileus and small-bowel obstruction (early: 43.8% vs late: 15.5%, p < 0.001) were leading causes for early readmissions, deep infections (3.9% vs 16.3%, p < 0.001) and acute kidney injury (0% vs 5%, p = 0.006) were mainly observed during readmissions after 48 hours.

LIMITATIONS:

Risk of underreporting due to loss of follow-up and the potential co-occurrence of complications were limitations of this study.

CONCLUSIONS:

Early hospital readmission was mainly due to ileus or bowel obstruction, whereas late readmissions were related to deep infections and acute kidney injury. A suspicious attitude toward potential ileus-related symptoms before discharge and dedicated education for ostomy patients are important. A short index hospital stay was not associated with increased readmission rates. See Video Abstract at http://links.lww.com/DCR/B237. REINGRESOS DENTRO DE LAS 48 HORAS POSTERIORES AL ALTA: RAZONES, FACTORES DE RIESGO Y POSIBLES MEJORAS: La tasa de reingreso hospitalario es una métrica de calidad importante y ha sido reconocida como una medida clave de los programas hospitalarios de compras basadas en el valor.Evaluar los factores de riesgo para el reingreso hospitalario con énfasis en reingresos tempranos potencialmente prevenibles dentro de las 48 horas posteriores al alta.Estudio de cohorte retrospectivo.Institución académica terciaria con programa de recuperación mejorada estandarizado.Pacientes consecutivos sometidos a resecciones colorrectales mayores electivas entre 2011 y 2016.Se identificaron factores de riesgo uni y multivariables para reingresos totales y tempranos (<48 horas). Se compararon razones médicas y quirúrgicas específicas para el reingreso entre reingresos tempranos y tardíos.En total, 526/4204 pacientes (12,5%) fueron readmitidos dentro de los 30 días posteriores al alta. Los factores de riesgo independientes fueron puntuación ASA (≥3, OR 1.5; IC 95% 1.1-2), aumento de peso perioperatorio excesivo (OR 1.7; IC 95% 1.3-2.3), ileostomía (OR 1.4, IC 95%: 1-2) y transfusión (OR 2, IC 95% 1.4-3) o reoperación (OR 11.4; IC 95% 7.4-17.5) durante la estadía índice. No se identificó ningún factor de riesgo potencialmente prevenible para el reingreso temprano (128 pacientes, 24.3% de todos los reingresos, 3% de la cohorte total), y la estadía hospitalaria índice de ≤ 3 días no se asoció con un aumento en el reingreso (OR 0.9; IC 95% 0.7-1.2) Mientras que el íleo / obstrucción del intestino delgado (temprano: 43.8% vs. tardío: 15.5%, p < 0.001) fueron las principales causas de reingresos tempranos, infecciones profundas (3.9% vs 16.3%, p < 0.001) y lesión renal aguda (0 vs 5%, p = 0.006) se observaron principalmente durante los reingresos después de 48 horas.Riesgo de subregistro debido a la pérdida en el seguimiento, posible co-ocurrencia de complicaciones.El reingreso hospitalario temprano se debió principalmente a íleo u obstrucción intestinal, mientras que los reingresos tardíos se relacionaron con infecciones profundas y lesión renal aguda. Es importante tener una actitud suspicaz hacia los posibles síntomas relacionados con el íleo antes del alta y una educación específica para los pacientes con ostomía. La estadía hospitalaria índice corta no se asoció con mayores tasas de reingreso. Consulte Video Resumen en http://links.lww.com/DCR/B237.

• Authors: Fabian Grass, Jacopo Crippa, Jenna K Lovely, James Ansell, Kevin T Behm, Pietro Achilli, Martin Hübner, Scott R Kelley, Kellie L Mathis, Eric J Dozois, David W Larson
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 63 Issue 8 Pg. 1142-1150 (08 2020) ISSN: 1530-0358 [Electronic] United States
• PMID: 32692075 (Publication Type: Journal Article, Webcast)

Topics

• Acute Kidney Injury (epidemiology)
• Adult
• Aged
• Colectomy (methods)
• Elective Surgical Procedures (adverse effects)
• Enhanced Recovery After Surgery (standards)
• Female
• Humans
• Ileostomy (statistics & numerical data)
• Ileus (epidemiology)
• Infections (epidemiology)
• Length of Stay (statistics & numerical data)
• Male
• Middle Aged
• Patient Discharge (standards)
• Patient Readmission (statistics & numerical data)
• Perioperative Period (trends)
• Postoperative Complications (epidemiology)
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Risk Factors
• Weight Gain (physiology)