Hospital readmissions after liver surgery for metastatic colorectal cancer

• Published in: Surgery 2015-02, Vol.157 (2), p.231-238
• Main Authors: Tamandl, Dietmar, MD, Butte, Jean M., MD, Allen, Peter J., MD, D'Angelica, Michael I., MD, DeMatteo, Ronald P., MD, Groeger, Jeffrey S., MD, Jarnagin, William R., MD, Fong, Yuman, MD
• Format: Article
• Language: English
• Subjects: Aged; Cohort Studies; Colorectal Neoplasms; Female; Hepatectomy - adverse effects; Humans; Length of Stay; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Middle Aged; Patient Readmission; Postoperative Complications - etiology; Postoperative Complications - therapy; Quality of Health Care; Surgery; Time Factors
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.09.016

Background Hospital readmission rates after surgery are increasingly used as a measure of quality of care. Numerous efforts to decrease these rates have been established by care providers and insurance companies. There is sparse information available regarding readmission rates after liver resection for metastatic colorectal cancer (mCRC). Methods Data from hospital readmissions occurring within 30 days after liver resection and/or open ablation for mCRC between 2005 and 2010 were captured from the urgent care center (emergency room) database and were compared with data from the institutional database. Complications during the primary stay and those leading to readmission were analyzed and graded with an established scoring system. The time course of complications and their therapeutic management were analyzed as well. Results Of 746 patients who underwent surgery during this period, 277 (37%) developed medical or surgical complications within 30 days, and 97 (13%) required readmission after discharge. The most common causes for readmission were perihepatic or intra-abdominal collections (40%), wound issues (13%), and gastrointestinal issues (12%). Forty-four patients had complications grade 3 or higher during readmission, thus representing 34% of all major complications (grade 3 or higher). Seventy-four readmitted patients (27% of all patients with complications) had a complication of lesser grade during their primary stay. The median postoperative day of readmission was 15 (range, 6–30) with wide variation among complication types. Conclusion Readmission is common after liver resection and/or ablation for mCRC. One quarter of patients who develop complications postoperatively will have their most significant complication as an outpatient and require rehospitalization.