Predicting colorectal surgery readmission risk: a surgery-specific predictive model

Abstract

Most current predictive models for risk of readmission were primarily designed from non-surgical patients and often utilize administrative data alone. Models built upon comprehensive data sources specific to colorectal surgery may be key to implementing interventions aimed at reducing readmissions. This study aimed to develop a predictive model for risk of 30-day readmission specific to colorectal surgery patients including administrative, clinical, laboratory, and socioeconomic status (SES) data. Patients admitted to the colorectal surgery service who underwent surgery and were discharged from an academic tertiary hospital between 2017 and 2019 were included. A total of 1549 patients met eligibility criteria for this retrospective split-sample cohort study. The 30-day readmission rate of the cohort was 19.62%. A multivariable logistic regression was developed (C = 0.70, 95% CI 0.61–0.73), which outperformed two internationally used readmission risk prediction indices (C = 0.58, 95% CI 0.52–0.65) and (C = 0.60, 95% CI 0.53–0.66). Tailored surgery-specific readmission models with comprehensive data sources outperform the most used readmission indices in predicting 30-day readmission in colorectal surgery patients. Model performance is improved by using more comprehensive datasets that include administrative and socioeconomic details about a patient, as well as clinical information used for decision-making around the time of discharge.

Keywords:

• Logistic regression
• readmission risk
• colorectal surgery
• clinical decision making

Acknowledgment

The content is solely the responsibility of the authors and does not necessarily represent the official views of any of the NIH or either funding source.

Consent and approval statement

This study has been exempted according to category 4 as secondary research for health care operations, for which consent is not required, as approved by the Institutional Review Board at the University of North Carolina, IRB 250341.

Disclosure statement

The authors report no conflicts of interest.

Funding/support

This project was supported from the Duke Cancer Institute as part of the P30 Cancer Center Support Grant (Grant ID: P30 CA014236). This project was also supported by grant number F32HS026363 from the Agency for Healthcare Research and Quality, and the Research Foundation of the American Society of Colon and Rectal Surgeons—General Surgery Resident Research Initiation Grant GSRRIG 042.

Role of the funder

The Duke Cancer Institute, Agency for Healthcare Research and Quality, and American Society of Colon and Rectal Surgeons had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

C. HOSPITAL (Hemoglobin, Oncology service, Sodium level, Procedure, Index Type of admission, prior Admissions, and Length of stay) score