Hospital Variation in Readmissions and Visits to the Emergency Department Following Ileostomy Surgery
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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.
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.
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.
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.
KeywordsIleostomy Hospital readmission Colorectal surgery Colectomy
We are grateful for the participation of the MSQC hospitals, their MSQC nurses, and their surgeon champions.
SK and KH designed the study, drafted and revised the work, approved it to be published, and agreed to be accountable to all aspects of the work. JV, PS, and NK contributed the analysis and interpretation of data, revised the work critically, approved it to be published, and agreed to be accountable to all aspects of the work.
There was no direct grant support for this study, but several authors have research support:
- Dr. Hendren receives financial support for research from the American Society of Colon and Rectal Surgeons Research Foundation.
- Dr. Vu receives financial support for research from the Ruth L Kirschstein National Research Service Award (1F32DK115340-01A1).
- Dr. Suwanabol receives funding for research from the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons Research Foundation, and the American College of Surgeons.
- Dr. Hardiman receives funding from the National Cancer Institute, K08CA190645.
- The Michigan Surgical Quality Collaborative (the setting and data source for this research study) is funded by Blue Cross and Blue Shield of Michigan (BCBSM). By agreement, BCBSM is not provided with individual hospital performance data but sees only aggregate and de-identified data. There was no influence from BCBSM in the study design, data collection or analysis, writing, or decision to submit this work for publication.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
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