Analysis of associated factors of unplanned readmission within 30 days after discharge in colorectal cancer patients who underwent enhanced recovery after surgery mode_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Yuhua ,  YANG Jie , JIANG Lili

West China School of Nursing, Sichuan University/Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

YANG Jie, Email: 18980606084@126.com

Keywords：

enhanced recovery after surgery; colorectal cancer; unplanned readmission

DOI：

10.7507/1007-9424.202007113

Video：

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Objective To understand the current situation of unplanned readmission of colorectal cancer patients within 30 days after discharge under the enhanced recovery after surgery (ERAS) mode, and to explore the influencing factors.Methods From May 7, 2018 to May 29, 2020, 315 patients with colorectal cancer treated by Department of Gastrointestinal Surgery, West China Hospital, Sichuan University and managed by ERAS process during perioperative period were prospectively selected as the research objects. The general data, clinical disease data and discharge readiness of patients were obtained by questionnaire and electronic medical record. Telephone follow-up was used to find out whether the patient had unplanned readmission 30 days after discharge and logistic regression was used to analyze the influencing factors of unplanned readmission within 30 days after discharge.Results Within 30 days after discharge, 37 patients were admitted to hospital again, the unplanned readmission rate was 11.7%. The primary cause of readmission was wound infection. Logistic regression analysis showed that the body mass decreased by more than 10% in recent half a year (OR=2.611, P=0.031), tumor location in rectum (OR=3.739, P=0.026), operative time ≤3 hours (OR=0.292, P=0.004), and discharge readiness (OR=0.967, P<0.001) were independent predictors of unplanned readmission.Conclusions Under the ERAS mode, the readmission rate of colorectal cancer patients within 30 days after discharge is not optimistic. Attention should be focused on patients with significant weight loss, rectal cancer, more than 3 hours of operative time, and low readiness for discharge. Among them, the patient’s body weight and discharge readiness are the factors that can be easily improved by clinical intervention. It can be considered as a new way to reduce the rate of unplanned readmission by improving the patients’ physical quality and carrying out discharge care program.

Citation： HE Yuhua, YANG Jie, JIANG Lili. Analysis of associated factors of unplanned readmission within 30 days after discharge in colorectal cancer patients who underwent enhanced recovery after surgery mode. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(10): 1334-1339. doi: 10.7507/1007-9424.202007113 Copy

1.	周念松, 张俊, 马谢民, 等. 北京市某三甲医院31天内非计划性再入院研究. 中国医院管理, 2010, 30(4): 18-20.
2.	Hoffman RL, Bartlett EK, Ko C, et al. Early discharge and readmission after colorectal resection. J Surg Res, 2014, 190(2): 579-586.
3.	Lovely JK, Maxson PM, Jacob AK, et al. Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery. Br J Surg, 2012, 99(1): 120-126.
4.	Pedersen MK, Nielsen GL, Uhrenfeldt L, et al. Risk assessment of acute, all-cause 30-day readmission in patients aged 65⁺: a nationwide, register-based cohort study. J Gen Intern Med, 2019, 34(2): 226-234.
5.	Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec, 2007, 21(1): 31-42.
6.	Zhao H, Feng X, Yu R, et al. Validation of the Chinese version of the readiness for hospital discharge scale on patients who have undergone laryngectomy. J Nurs Res, 2015, 24(4): 321-328.
7.	Smith TW Jr, Wang X, Singer MA, et al. Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties. Am J Surg, 2020, 219(3): 530-534.
8.	Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
9.	Curtis NJ, Noble E, Salib E, et al. Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival? Colorectal Dis, 2017, 19(8): 723-730.
10.	Francis NK, Mason J, Salib E, et al. Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis, 2015, 17(7): O148-O154.
11.	Pucciarelli S, Zorzi M, Gennaro N, et al. In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study. Eur J Surg Oncol, 2017, 43(7): 1312-1323.
12.	Almussallam B, Joyce M, Marcello PW, et al. What factors predict hospital readmission after colorectal surgery? Am Surg, 2016, 82(5): 433-438.
13.	Orcutt ST, Li LT, Balentine CJ, et al. Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort. J Surg Res, 2016, 201(2): 370-377.
14.	茅红燕, 赵琼兰. 结直肠癌患者手术部位感染及其影响因素的研究进展. 中国实用护理杂志, 2017, 33(27): 2154-2157.
15.	Kwaan MR, Vogler SA, Sun MY, et al. Readmission after colorectal surgery is related to preoperative clinical conditions and major complications. Dis Colon Rectum, 2013, 56(9): 1087-1092.
16.	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
17.	Doumouras AG, Tsao MW, Saleh F, et al. A population-based comparison of 30-day readmission after surgery for colon and rectal cancer: How are they different? J Surg Oncol, 2016, 114(3): 354-360.
18.	Ridolfi TJ, Berger N, Ludwig KA. Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg, 2016, 29(3): 239-245.
19.	Turina M, Remzi FH, Dietz DW, et al. Quantification of risk for early unplanned readmission after rectal resection: a single-center study. J Am Coll Surg, 2013, 217(2): 200-208.
20.	Esemuede IO, Gabre-Kidan A, Fowler DL, et al. Risk of readmission after laparoscopic vs. open colorectal surgery. Int J Colorectal Dis, 2015, 30(11): 1-6.
21.	王树江, 张明, 刘鹏, 等. 结直肠癌术后切口感染的影响因素. 中华医院感染学杂志, 2019, 29(21): 3270-3274.
22.	Fenwick AM. An interdisciplinary tool for assessing patients’ readiness for discharge in the rehabilitation setting. J Adv Nurs, 1979, 4(1): 9-21.
23.	杨婕, 贺育华, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度与短期生活质量的相关性. 中国普外基础与临床杂志, 2019, 26(2): 157-161.
24.	贺育华, 杨婕, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度护患评估差异性分析. 中国普外基础与临床杂志, 2018, 25(12): 1449-1453.
25.	Kaya S, Sain Guven G, Aydan S, et al. Patients’ readiness for discharge: predictors and effects on unplanned readmissions, emergency department visits and death. J Nurs Manag, 2018, 26(6): 707-716.
26.	Lau D, Padwal RS, Majumdar SR, et al. Patient-reported discharge readiness and 30-day risk of readmission or death: a prospective cohort study. Am J Med, 2016, 129(1): 89-95.
27.	蒋超, 蒲杰, 谢静. 我国台湾地区医院出院准备服务的特点及启示. 中国医疗管理科学, 2017, 7(2): 27-30.
28.	Larsson C, Wgstrm U, Normann E, et al. Parents experiences of discharge readiness from a Swedish neonatal intensive careunit. Nurs Open, 2016, 4(2): 90-95.
29.	Roy C. Extending the roy adaptation model to meet changing global needs. Nurs Sci Q, 2011, 24(4): 345-351.
30.	Mansouri A, Baraz S, Elahi N, et al. The effect of an educational program based on Roy’s adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study. Jpn J Nurs Sci, 2019, 16(4): 459-467.
31.	贺育华, 杨婕, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度与出院指导质量现状调查. 护理学杂志, 2019, 34(10): 17-19.

1. 周念松, 张俊, 马谢民, 等. 北京市某三甲医院31天内非计划性再入院研究. 中国医院管理, 2010, 30(4): 18-20.
2. Hoffman RL, Bartlett EK, Ko C, et al. Early discharge and readmission after colorectal resection. J Surg Res, 2014, 190(2): 579-586.
3. Lovely JK, Maxson PM, Jacob AK, et al. Case-matched series of enhanced versus standard recovery pathway in minimally invasive colorectal surgery. Br J Surg, 2012, 99(1): 120-126.
4. Pedersen MK, Nielsen GL, Uhrenfeldt L, et al. Risk assessment of acute, all-cause 30-day readmission in patients aged 65⁺: a nationwide, register-based cohort study. J Gen Intern Med, 2019, 34(2): 226-234.
5. Weiss ME, Piacentine LB, Lokken L, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec, 2007, 21(1): 31-42.
6. Zhao H, Feng X, Yu R, et al. Validation of the Chinese version of the readiness for hospital discharge scale on patients who have undergone laryngectomy. J Nurs Res, 2015, 24(4): 321-328.
7. Smith TW Jr, Wang X, Singer MA, et al. Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties. Am J Surg, 2020, 219(3): 530-534.
8. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg, 2002, 183(6): 630-641.
9. Curtis NJ, Noble E, Salib E, et al. Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival? Colorectal Dis, 2017, 19(8): 723-730.
10. Francis NK, Mason J, Salib E, et al. Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis, 2015, 17(7): O148-O154.
11. Pucciarelli S, Zorzi M, Gennaro N, et al. In-hospital mortality, 30-day readmission, and length of hospital stay after surgery for primary colorectal cancer: A national population-based study. Eur J Surg Oncol, 2017, 43(7): 1312-1323.
12. Almussallam B, Joyce M, Marcello PW, et al. What factors predict hospital readmission after colorectal surgery? Am Surg, 2016, 82(5): 433-438.
13. Orcutt ST, Li LT, Balentine CJ, et al. Ninety-day readmission after colorectal cancer surgery in a Veterans Affairs cohort. J Surg Res, 2016, 201(2): 370-377.
14. 茅红燕, 赵琼兰. 结直肠癌患者手术部位感染及其影响因素的研究进展. 中国实用护理杂志, 2017, 33(27): 2154-2157.
15. Kwaan MR, Vogler SA, Sun MY, et al. Readmission after colorectal surgery is related to preoperative clinical conditions and major complications. Dis Colon Rectum, 2013, 56(9): 1087-1092.
16. 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
17. Doumouras AG, Tsao MW, Saleh F, et al. A population-based comparison of 30-day readmission after surgery for colon and rectal cancer: How are they different? J Surg Oncol, 2016, 114(3): 354-360.
18. Ridolfi TJ, Berger N, Ludwig KA. Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg, 2016, 29(3): 239-245.
19. Turina M, Remzi FH, Dietz DW, et al. Quantification of risk for early unplanned readmission after rectal resection: a single-center study. J Am Coll Surg, 2013, 217(2): 200-208.
20. Esemuede IO, Gabre-Kidan A, Fowler DL, et al. Risk of readmission after laparoscopic vs. open colorectal surgery. Int J Colorectal Dis, 2015, 30(11): 1-6.
21. 王树江, 张明, 刘鹏, 等. 结直肠癌术后切口感染的影响因素. 中华医院感染学杂志, 2019, 29(21): 3270-3274.
22. Fenwick AM. An interdisciplinary tool for assessing patients’ readiness for discharge in the rehabilitation setting. J Adv Nurs, 1979, 4(1): 9-21.
23. 杨婕, 贺育华, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度与短期生活质量的相关性. 中国普外基础与临床杂志, 2019, 26(2): 157-161.
24. 贺育华, 杨婕, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度护患评估差异性分析. 中国普外基础与临床杂志, 2018, 25(12): 1449-1453.
25. Kaya S, Sain Guven G, Aydan S, et al. Patients’ readiness for discharge: predictors and effects on unplanned readmissions, emergency department visits and death. J Nurs Manag, 2018, 26(6): 707-716.
26. Lau D, Padwal RS, Majumdar SR, et al. Patient-reported discharge readiness and 30-day risk of readmission or death: a prospective cohort study. Am J Med, 2016, 129(1): 89-95.
27. 蒋超, 蒲杰, 谢静. 我国台湾地区医院出院准备服务的特点及启示. 中国医疗管理科学, 2017, 7(2): 27-30.
28. Larsson C, Wgstrm U, Normann E, et al. Parents experiences of discharge readiness from a Swedish neonatal intensive careunit. Nurs Open, 2016, 4(2): 90-95.
29. Roy C. Extending the roy adaptation model to meet changing global needs. Nurs Sci Q, 2011, 24(4): 345-351.
30. Mansouri A, Baraz S, Elahi N, et al. The effect of an educational program based on Roy’s adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study. Jpn J Nurs Sci, 2019, 16(4): 459-467.
31. 贺育华, 杨婕, 蒋理立, 等. 加速康复外科模式下结直肠癌患者出院准备度与出院指导质量现状调查. 护理学杂志, 2019, 34(10): 17-19.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of associated factors of unplanned readmission within 30 days after discharge in colorectal cancer patients who underwent enhanced recovery after surgery mode

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