Abstract
Aim: To define the 30-day unplanned readmission (UR) rate after colorectal surgery at Christchurch Public Hospital and to evaluate its use as a key performance indicator (KPI) of surgical care.
Methods: A systematic review and meta-analysis of the literature was undertaken. A retrospective study of patients who underwent curative colorectal cancer surgery between 2012 and 2017 was performed to derive and validate a prediction model for UR. A prospective study of patients who underwent colorectal surgery between 2018 and 2019 was performed to investigate frailty and social support as risk factors for UR.
Results: International UR rates ranged from 6% to 29% after colorectal surgery. Despite limitations from significant heterogeneity in the literature, increased comorbidity, stoma formation and postoperative complications were identified as potential predictors of UR. The retrospective analysis demonstrated that rectal cancer, stoma formation and postoperative complications were statistically significant predictors of UR after colorectal cancer surgery in New Zealand. A simple bivariable prediction model comprised of rectal cancer and postoperative complications predicted UR with an AUC of 0.62 on external validation. Frailty and Social support were not found to be significant risk factors for UR.
Conclusions: URs after colorectal cancer are common, predictable, and occur within two weeks of index discharge. The UR rate is a valid KPI indicator of elective colorectal surgery.