Nearly one-quarter of privately insured colon surgery patients are readmitted to the hospital within three months of discharge at a cost of roughly $9,000 per readmission, according to Johns Hopkins researchers, who've identified a major area for quality improvement and cost reduction in health care.
The most common reason for returning to the hospital: complications from surgical-site infections, which are likely preventable, they say.
Readmission rates, an increasingly popular yardstick by which hospitals are judged and penalized by insurers, are a major financial burden on the health care system. Nationwide, these findings account for $300 million in readmission costs annually for colorectal surgery alone.
"Readmissions after surgery are common and they burden the health care system with exorbitant costs," says Martin A. Makary, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine and the senior author of a report on the new study published in the December issue of the journal Diseases of the Colon & Rectum. "While readmissions are sometimes unavoidable, many times they result from poor coordination of medical care. Everyone knows you can't get readmissions down to zero but, at 23 percent, there's a huge amount of room for improvement.
There is no reason we can't cut that rate in half."
Says study leader Elizabeth Wick, M.D., an assistant professor of surgery at Johns Hopkins: "Hospital readmissions are costly to the patient, costly to the system, delay recovery and victimize some patients multiple times."
Using data from BlueCross BlueShield plans in eight states, Makary, Wick and their colleagues reviewed records of 10,882 patients who underwent colorectal surgery between 2002 and 2008. They found that 11.4 percent of patients were readmitted to the hospital within 30 days of discharge and another 12 percent were readmitted between days 31 and 90. Nearly 7 percent -- 725 patients -- were readmitted two or more times within the first three months after discharge.
Colorectal surgery patients are at high risk for readmission because of the location and complexity of their operations. Many suffer from a postsurgical infection or dehydration as the digestive system recovers from surgery. Stoma (ostomy) complications are also common. A stoma is sometimes needed to divert the intestinal tract outside the body.
Patients with a stoma are three times more likely to be readmitted within 30 days, and those with surgical-site infections are twice as likely, they found. Patients in the study needed colorectal surgery primarily because of cancer or diverticulitis, a chronic inflammation of the intestines. Nearly 19 percent of patients in the study contracted a surgical-site infection within 30 days of their operations.
Even a 5 percent reduction in surgical-site infections would have a significant impact on readmission rates and the associated costs, Wick says.
She notes that hospitals and surgeons are actively investigating ways to prevent surgical-site infections, and testing various interventions.