Hospital Variation in Readmissions and Visits to the Emergency Department Following Ileostomy Surgery
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ORIGINAL ARTICLE
Hospital Variation in Readmissions and Visits to the Emergency Department Following Ileostomy Surgery Samantha Hendren 1 & Joceline Vu 1
&
Pasithorn Suwanabol 1 & Neil Kamdar 2,3,4,5 & Karin Hardiman 1
Received: 16 April 2019 / Accepted: 9 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Ileostomy surgery is associated with a high readmission rate, and care pathways to prevent readmissions have been proposed. However, the extent to which readmission rates have improved is unknown. This study examined rates of readmission and emergency department visits (“return to hospital,” or RTH) across hospitals in Michigan. Methods This was a retrospective cohort study of patients undergoing colorectal surgery with ileostomy formation from July 2012 to August 2017 in twenty Michigan Surgical Quality Collaborative (MSQC) hospitals. Primary outcome was RTH within 30 days of surgery. Multivariable logistic regression was used to identify risk factors for RTH. RTH rates over time were calculated, and hospitals’ risk-adjusted rates were estimated using a multivariable model. Hospitals were divided into quartiles by risk-adjusted RTH rates, and RTH rates were compared between quartiles. Results Of 982 patients, 28.5% experienced RTH. Rates of RTH did not decrease over time. Adjusted hospital RTH rates ranged from 9.4 to 43.3%. The risk-adjusted rate in the best-performing hospital quartile was 17.5% vs. 37.3% in the worst-performing quartile (p < 0.001). Hospitals that were outliers for ileostomy RTH were not outliers for colorectal resection RTH in general. Conclusions Rates of RTH following ileostomy surgery are high and vary between hospitals. This suggests inconsistent or ineffective use of pathways to prevent these events and potential for improvement. There is clear opportunity to standardize care to prevent RTH after ileostomy surgery. Keywords Ileostomy . Hospital readmission . Colorectal surgery . Colectomy
Introduction Meeting Presentation: American Society of Colon and Rectal Surgeons Annual Meeting, Nashville, TN, poster presentation. May 19–23, 2018. * Samantha Hendren [email protected] 1
Department of Surgery, University of Michigan, 2124 Taubman Center, 1500 E. Medical Center Dr., SPC 5343, Ann Arbor, MI 48109, USA
2
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
3
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
4
Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
5
Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
More than 38,000 Americans undergo ileostomy surgery each year for rectal cancer, inflammatory bowel disease, diverticulitis, and other conditions.1 It is known that ileostomy surgery is associated with a very high rate of readmissions, due to complications including dehydration.2–9 To address this problem, several groups have implemented programs to decrease readmission rates for ile
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