Not All Discharge Settings Are Created Equal: Thirty-Day Readmission Risk after Elective Colorectal Surgery

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 READMISION A 30 DIAS DESPUES DE CIRUGIA COLORRECTAL ELECTIVA: El alta hospitalaria hacia el domicilio luego de una reseccion colorrectal puede aumentar el riesgo de readmision.Determinar el impacto de varias configuraciones diferentes de alta en la readmision a 30 dias luego de ajustar factores demograficos y clinicos.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 reseccion colorrectal electiva.Los riesgos de readmision hospitalaria a 30 dias.La edad media de la poblacion estudiada (n = 97,455) fue de 58 anos; 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 enfermeria especializada, 1% alta hacia un centro de rehabilitacion y <1% alta hacia un hospital con atencion a largo plazo. La tasa global de readmision fue del 12%; nueve por ciento desde domicilios sin servicios complementarios, 16% desde domicilios con servicios de salud organizados, 19% desde un centro de enfermeria especializada, 34% desde el centro de rehabilitacion y 22% desde un hospital con atencion a largo plazo (p <0.001). Los pacientes con estadias en Unidad de Cuidados Intensivos, con mas complicaciones postoperatorias y con una hospitalizacion prolongada tenian mas probabilidades de ser dados de alta hacia un domicilio con servicios de salud organizados o hacia un centro de rehabilitacion (p <0,001). El alta hospitalaria con servicios organizados de atencion medica domiciliaria, centros de enfermeria especializada o centros de rehabilitacion aumentaron el riesgo de readmision ajustada de multiples 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 fue asociada con un mayor riesgo de readmision ajustada (OR 1.2, IC 95% 0.9-1.6), no obstante que este grupo fue el que tuvo las mayores comorbilidades y complicaciones postoperatorias. Entre los pacientes readmitidos dentro de los 30 dias, 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 enfermeria especializada (8), centros de rehabilitacion (9) y hospitales con atencion a largo plazo (12) (p <0,001).Naturaleza retrospectiva del presente estudio.El alta hospitalaria con servicios de salud domiciliarios organizados, hacia centros de enfermeria especializada o hacia centros de rehabilitacion se asocian con un mayor riesgo ajustado de readmision en comparacion con el alta domiciliaria de rutina y los hospitales con atencion a largo plazo. Los objetivos potenciales para disminuir la readmision incluyen mejorar la transicion de la atencion al momento del alta, mejorar la calidad de la atencion despues del alta y mejorar las diferentes facilidades para los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B272.