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  • Title: Early discharge and readmission after colorectal resection.
    Author: Hoffman RL, Bartlett EK, Ko C, Mahmoud N, Karakousis GC, Kelz RR.
    Journal: J Surg Res; 2014 Aug; 190(2):579-86. PubMed ID: 24661387.
    Abstract:
    BACKGROUND: Emphasis on the provision of high quality, cost-effective healthcare has meant increasing efforts at reducing postoperative length of stay while reducing 30-d readmission rates. The aim of this study was to identify factors associated with early discharge (ED) and to evaluate the effectof ED on readmission after colorectal resection. MATERIALS AND METHODS: We identified all inpatients aged ≥18 y who underwent a colorectal resection in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, 2011. ED was defined as a length of stay ≤25th percentile by procedure (rectal resection, open colectomy, and laparoscopic colectomy). Multivariate logistic regression was used to identify factors significantly associated with ED and readmission. A subset analysis was performed by procedure type. RESULTS: Of 28,532 patients, 2171 (7%) underwent rectal resection, 14,976 (52%) underwent open colectomy, and 11,385 (40%) underwent laparoscopic colectomy with an ED on or before postoperative days 5, 5, and 3, respectively. The overall cohort included patients with a mean age of 61 y. A total of 52% were women and 37% were colorectal cancer patients. Age >65 y, recent steroid use, simultaneous ostomy creation, nonelective surgery, need for reoperation, and a postoperative occurrence before discharge were significantly associated with a reduced likelihood of ED. The overall rate of readmission was 12%. Patients who were discharged early were significantly less likely to be readmitted (odds ratio, 0.77; 95% confidence interval, 0.70-0.84). CONCLUSIONS: In the appropriate patient population, ED after colorectal surgery may be implemented without any adverse effect on readmission rates.
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