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Hospital Readmissions and Emergency Department Visits Following Laparoscopic and Open Colon Resection for Cancer.
Hansen, Captain Dallas G. M.D. 1; Fox, Captain Justin P. M.D., M.H.S. 1,2; Gross, Cary P. M.D. 2,3,4; Bruun, Lieutenant Colonel John S. M.D. 1
[Article] Diseases of the Colon & Rectum. 56(9):1053-1061, September 2013.

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BACKGROUND: Laparoscopic colectomy for the treatment of colon cancer has been widely adopted in community practice, in part, because of shorter hospitalizations. The benefits of a shorter hospital stay are only realized if readmissions and emergency department visits, collectively termed revisits, do not increase after discharge. We conducted a population-based analysis to determine whether hospitals with higher laparoscopic colectomy rates have higher revisit rates.

OBJECTIVE: The aim of this study was to determine whether hospital utilization after discharge is increased for patients undergoing laparoscopic colectomy for cancer.

DESIGN: This is a retrospective cohort study.

SETTINGS: Data were gathered from the Healthcare Cost and Utilization Project's inpatient and emergency department databases for California. These databases include data from all nonfederal hospitals in the State of California.

PATIENTS: Patients who underwent elective colectomy for cancer from 2008 to 2009 were included.

INTERVENTIONS: The primary intervention was elective colectomy with the use of the open or laparoscopic approach.

MAIN OUTCOME MEASURES: The correlation between hospital laparoscopy rates and hospital readmission rates, emergency department visit rates, and revisit rates was calculated.

RESULTS: Overall, 6760 patients were treated at 176 hospitals. For every 100 patients discharged, there were 14.0 readmissions and 9.2 emergency department encounters. At the hospital level, laparoscopy rates varied considerably (median = 45.7%, range = 2.2%-88.9%), as did the risk-standardized readmission (12.1%, 8.6%-16.5%), emergency department encounter (7.8%, 4.1%-18.0%), and revisit rates (17.9%, 13.0%-26.4%). A hospital's laparoscopy rate was not significantly correlated with its risk-standardized readmission (weighted correlation coefficient = 0.05, p = 0.50), emergency department encounter (-0.11, p = 0.16), or revisit (-0.03, p = 0.70) rates.

LIMITATIONS: There are inherent limitations when using administrative data.

CONCLUSIONS: Hospitals where a greater proportion of colon resections for cancer are approached laparoscopically do not have higher 30-day, risk-standardized readmission, emergency department encounter, or revisit rates.