Developing A Predictive Model for Risk of Hospital Readmission After A Colorectal Surgery.
patients at high-risk of hospital readmission after colorectal surgery is necessary to
help reduce those readmissions. We aimed to develop and internally validate a model that
can predict hospital readmission risk for patients undergoing colorectal surgery. Our
model was designed to be used before discharging the patient from hospital. We performed
a retrospective cohort... read moreanalysis on data collected from a colorectal surgery department
at a tertiary care center. All patients who underwent colorectal surgery between July
16, 2007 and June 30, 2011 were included. Our main outcome was readmission within
30-days of hospital discharge. Generalized estimating equations were used to measure the
association between various clinical and demographic variables and hospital readmission
risk, while accounting for the possible correlation between operative encounters caused
by patients that had more than one encounter. A backward selection method was used to
select variables for the final model. Overall performance, calibration and
discrimination of the predictive models were assessed. The model was internally
validated using bootstrapping. In a cohort of 4,522 operative encounters (from 3,628
patients), 449 (9.9%) (from 402 patients) were readmitted to the hospital within 30-days
of discharge. The final predictive model included the following factors: age, length of
stay, patient setting, comorbidity score, use of alcohol, surgery time, surgery urgency
and use of anxiolytic medications. Longer length of stay (OR=1.02 (1.01, 1.03)),
inpatient procedure (OR=3.6 (2.41, 5.38)), higher comorbidity score (OR=1.1 (1.06,
1.17)), not drinking alcohol (OR for drinking=0.6 (0.56, 0.84)), longer surgery time
(OR=1.1 (1.07, 1.22)) and anxiolytics use (OR=1.8 (1.40, 2.30)) were all significantly
associated with increased readmission risk (p-value <0.05). The model performed
similarly in the original and internally validated set. We were limited by the
single-center retrospective study nature and we were unable to capture readmissions
outside the study center. In conclusion, the risk of hospital readmission after a
colorectal surgery can be predicted using a simple predictive model. Future studies are
needed to externally validate this model.
Thesis (M.S.)--Tufts University, 2015.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Rocco Ricciardi.
Committee: David Kent, and Robin Ruthazer.
Keywords: Surgery, Public health, and Health care management.read less