In this retrospective population-based cohort study, we found that 13.76% of CRC patients were readmitted within 30-day of index hospitalization, a finding that is slightly higher than previous studies (9–11%) [4,12,13,14,15,16,17]. The majority of recorded reasons for hospital readmissions were gastrointestinal (22.45%), urinary tract infection (16.33%), and surgical site infection (12.24%). Almost one-quarter of metastatic patients were readmitted within 30 day of index hospitalization.
While previous studies found that 22% to 27% of metastatic CRC patients were readmitted [18,19,20,21,24], we observed that 24.30% (17/70) of our metastatic patients were readmitted. In the multivariable analysis, metastatic patients had 3.86 higher odds of 30-day hospital readmission compared to those with localized disease, similar to previous findings [22,23]. Several studies from Saudi Arabia have shown that a sizable percentage of Saudi CRC patients were diagnosed at an advanced stage [2,9], a risk factor that has been shown to increase readmission in our population. Moreover, we found that patients discharged to locations other than post anesthesia care unit were more likely to be readmitted.
Taken together, hospitalized patients with metastatic disease should be counseled before discharge, for example through outpatient transition [24], to reduce hospital readmission. Alternatively, down-staging efforts through an early stage at diagnosis, as secondary public health prevention, will indirectly reduce the rate of hospital readmission [2,9].
Similar to some but not all prior research, we found no association between readmission and comorbidities, LOS, or surgical approach. In a population-based study that assessed readmission rates in the VA population, the authors found no significant association between the aforementioned factors on the rate of readmission [25]. On the contrary, some other studies found a positive association with comorbidities, LOS, and open surgery. Notably, our population has longer index hospitalization compared to other populations [4,5,13,26]. It is possible that lack of association is due to the small observed number in the readmitted patients particularly those with > one comorbidity score.
The results of the present study should be interpreted within the scope of the following limitations. First, the reported results should be generalized to the MNG-HA population or a similar population. Second, SES is a factor that was affecting readmission in some previous studies which were not accounted for in the current study. Nonetheless, given that the MNG-HA population has equitable access to care and that all members are employed by the system, the SES effect is modest. Third, among patients with metastatic disease, we were not able to distinguish between primary tumor resection from metastatic resection. Fourth, given the positive volume-outcome relationship in CRC patients, adjusting for such factors could have improved the finding of the present study. Lastly, some of our admitted patients (n = 128) were missing discharge date and were excluded from analysis. The characteristics of these patients, nonetheless, were similar to our study population (Additional file 1: Appendix 2).
The knowledge of the rate and factors for hospital readmission in CRC patients has a significant impact on patients and the healthcare system. Given the identified factors, implementing strategies that may reduce readmission rates is needed. For instance, the adoption of minimally invasive surgery (e.g. laparoscopic procedure) could potentially contribute to lower hospitalization after major surgeries such as CRC. Additionally, post-discharge strategies include shorter outpatient follow-up time, nursing or home health care visits, and making a nursing/ educator home phone call. Many other modalities may be studied and implemented.