Hospital readmissions after colon surgery are common, costly and preventable, new research has found.
Nearly 1 in 4 privately insured colon surgery patients are readmitted to the hospital within 3 months of discharge at a cost of roughly $9,000 per readmission, according to Johns Hopkins researchers. They found that complications from largely preventable surgical-site infections are the most common reason for returning to the hospital.
"Readmissions after surgery are common and they burden the health care system with exorbitant costs," says Martin A. Makary, MD, MPH, an associate professor of surgery at the Johns Hopkins University School of Medicine and the senior author of a report on the new study published in the December issue of the journal Diseases of the Colon & Rectum. "While readmissions are sometimes unavoidable, many times they result from poor coordination of medical care. Everyone knows you can't get readmissions down to zero but, at 23, there's a huge amount of room for improvement. There is no reason we can't cut that rate in half."
Using data from Blue Cross/Blue Shield plans in 8 states, researchers reviewed records of 10,882 patients who underwent colorectal surgery between 2002 and 2008. They found that 11.4% of patients were readmitted to the hospital within 30 days of discharge and another 12% were readmitted between days 31 and 90. Nearly 7% (725 patients) were readmitted 2 or more times within the first 3 months after discharge.
By its very nature, colorectal surgery is a procedure that puts patients at high risk for readmission, researchers note. First, there's the location and complexity of the operations. Many patients also suffer from post-surgical infections or dehydration as the digestive system recovers from surgery. Ostomy complications are also common. Patients with a stoma are 3 times more likely to be readmitted within 30 days, and those with surgical-site infections are twice as likely, researchers found.
Even a 5% reduction in surgical-site infections would have a significant impact on readmission rates and the associated costs, they say. Here's how you can reduce readmissions:
Have nurses review patients' discharge plans before they leave, make follow-up appointments and review medication lists, tasks shown to prevent some return visits to the emergency department for minor concerns.
Have nurses follow up with patients by phone in the days after discharge. Those deemed at high risk for readmission should receive home visits from a nurse.
Both of these interventions are significantly less expensive than the cost of a new hospital stay.
Dan O'Connor
