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Early discharge after colorectal cancer resection: trends and impact on patient outcomes

  • 2021 SAGES Oral
  • Published:
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Abstract

Background

Implementation of early discharge in colorectal surgery has been effective in improving patient satisfaction and reducing healthcare costs. Readmission rates following early discharge among colorectal cancer patients are believed to be low, however, remain understudied. The objectives of this study were: (i) to describe trends in early post-operative discharge and the associated hospitalization costs; (ii) to explore patient outcomes and resource utilization following early discharge; and (ii) to identify predictors of readmission following early discharge.

Methods

This was a retrospective cohort study using the Nationwide Readmissions Database. Adult patients admitted with a primary colorectal neoplasm who underwent colectomy or proctectomy between 2010 and 2017 were identified using ICD-9/10 codes. The exposure of interest was early post-operative discharge defined as ≤ 3 days from surgery. Main outcome measures were 30-day readmissions, post-operative complication rates, LOS and cost.

Results

In total, 342,242 patients were identified, and of those, 51,977 patients (15.2%) had early discharges. During the study period, the proportion of early discharges significantly increased (R2 = 0.94), from 9.9 to 23.4%, while readmission rates in this group remained unchanged (mean 7.3% ± 0.5). Complications that required bounceback readmission (within 7 days) after early discharge, rather than during index admission, were an independent predictor of longer overall LOS (ß = 0.044, p < 0.001) and higher hospitalization costs (ß = 0.031, p < 0.001). On multiple logistic regression, factors independently associated with bounceback readmission following early discharge were: male gender (OR = 1.47, 95%CI 1.33–1.63); open surgery (OR = 1.37, 95%CI 1.23–1.52); presence of stoma (OR = 1.51, 95%CI 1.22–1.87); transfer to facility or discharge with home health service (OR = 1.53, 95%CI 1.34–1.75); and Medicare/Medicaid insurance (OR = 1.34, 95%CI 1.14–1.57), among others.

Conclusion

Early post-operative discharge of colorectal cancer patients is increasing despite a lack of improvement in readmission rates and an overall increase in hospitalization costs. Premature discharge of select patients may result in readmissions due to critical complications related to surgery resulting in increased resource utilization.

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Acknowledgements

The authors thank Georgia Rigas, Marie Demian, Sarah Faris-Sabboobeh, and Aashiyan Singh for their administrative assistance.

Funding

There is no grant support or funding for the study.

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Authors and Affiliations

  1. Department of Surgery, McGill University, Montreal, QC, Canada

    Jeongyoon Moon, Allison Pang, Gabriela Ghitulescu, Julio Faria, Nancy Morin, Carol-Ann Vasilevsky & Marylise Boutros

  2. Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada

    Marylise Boutros

Authors
  1. Jeongyoon Moon
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  2. Allison Pang
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  3. Gabriela Ghitulescu
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  4. Julio Faria
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  5. Nancy Morin
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  6. Carol-Ann Vasilevsky
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  7. Marylise Boutros
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Contributions

All authors contributed to the design of the study. JM, MB participated in data acquisition. JM, AP, GG, JF, NM, CAV, MB participated in data analysis and interpretation. JM and MB prepared the first draft of the manuscript. All authors contributed to, and approved, the final version of the manuscript.

Corresponding author

Correspondence to Marylise Boutros.

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Disclosures

Drs. Jeongyoon Moon, Allison Pang, Gabriela Ghitulescu, Julio Faria, Nancy Morin, and Carol-Ann Vasilevsky have no conflicts of interest or financial ties to disclose. Dr. Marylise Boutros received teaching honorarium from Johnson & Johnson.

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Moon, J., Pang, A., Ghitulescu, G. et al. Early discharge after colorectal cancer resection: trends and impact on patient outcomes. Surg Endosc 36, 6617–6628 (2022). https://doi.org/10.1007/s00464-021-08923-y

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  • DOI: https://doi.org/10.1007/s00464-021-08923-y

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