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.