Can we predict unplanned hospital readmission after colectomy for ulcerative colitis and indeterminate colitis?

Division of Colon and Rectal Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
The American surgeon (Impact Factor: 0.82). 11/2007; 73(10):998-1001.
Source: PubMed


Unplanned readmission (UR) is considered to be an index of quality surgical care. We examined whether any perioperative factor was associated with UR after colectomy for ulcerative colitis (UC) or indeterminate colitis (IC). Patients undergoing a two-stage or three-stage ileal pouch-anal anastomosis were included. Patient, disease, and surgical factors were collected. UR occurring within 30 days of hospital discharge was assessed. The 202 study patients had a median age of 38 years. Median body mass index was 22. There were 130 (64%) UC patients and 72 (36%) IC patients. Indications for surgery were medically refractory disease (n = 176, 87%) and dysplasia/cancer (n = 26, 13%). Preoperative medical therapy included steroids alone in 25 patients and steroids combined with other immunomodulators in 151 patients. A two-stage and three-stage ileal pouch-anal anastomosis was used in 146 (72%) and 56 (28%) patients, respectively. Median white blood cell count before discharge was 8600 cells/mm3. Median length of stay after surgery was 7 days. Complications before discharge were observed in 28 patients (14%). Thirty-eight patients (19%) had a UR. No preoperative or surgical factor was associated with UR. Although UR occurs frequently (19%) after colectomy for UC or IC, it cannot be predicted.

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    • "A second general viewpoint is that preventable readmissions are not about the quality of care [33,36]. Preventable readmissions are more about the person receiving care [24,29,44-46,48,55] and the viewpoint is marked by phrases like 'unpredictable sequel' [33] and 'cannot be predicted' [24,36]. "
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