Sa1096 Patient or Procedural Factors: What Drives Readmission After Surgery for Crohn's Disease?

Abstract

Background: Hospital readmission is associated with increased cost and worse patient outcomes. Readmission has emerged as a surrogate metric of quality. Crohn's disease (CD) patients requiring surgical management are at risk for hospital readmission, which may delay additional therapies. The aim of this study was to assess readmission rates at a tertiary IBD referral center and risk factors in post-operative CD patients in order to identify areas to target for improvement. Methods: We performed a cohort study of colorectal surgery patients captured in the National Surgical Outcome Improvement Program (NSQIP) database with the discharge ICD-9 diagnostic code of 555.x (Crohn's disease, CD) between January 2009-January 2012. Variables of interest included pre-operative medications, disease behavior and phenotype, and pre-operative comorbidities. Primary outcomes of interest were 30day post-operative readmission and post-operative complications. Results: There were 114 Crohn's patients admitted for surgical management of CD over the 3-year period with a 30-day readmission rate of 19.2% (n=22). Within this cohort, the 30-day post-operative complication rate (medical and/or surgical) was 19.2% (95% CI 10.9-24.7). Disease behavior (p=0.09) and location (p=0.70) were not significantly associated with readmission rates. Post-operative complications were the primary risk factor for readmission with 45.5% of readmitted patients experiencing post-operative complications compared to 13.0% among patients not requiring readmission (p=0.002). Average length of stay for the index admission was longer in readmitted patients compared to those not readmitted (13.9 ± 2.8 vs 8.0 ± 0.5 days; p=0.0008). Pre-operative steroid, biologic and immunomodulator use, TPN, weight loss, anemia, prior surgical history, disease duration or emergent surgery were not associated with readmission. Conclusions: Readmission after Crohn's disease surgery is primarily driven by the presence of post-operative complications, not CD location or phenotype. Efforts to reduce 30-day readmissions should focus on early recognition and prevention of postoperative complications. Further study is needed to determine the impact of readmission on the timeline for resuming CD therapies to prevent early disease recurrence.