Hemalkumar B Mehta, PhD1, Deepak Adhikari, MS1, Sneha D Sura, MS2, Byron D Hughes, MD, MPH1, Anthony J Senagore, MD, MS, MBA1. 1University of Texas Medical Branch, 2University of Houston
Introduction: Prior studies reported safety and effectiveness of laparoscopic colectomy in older patients, however impending changes in health care reimbursement will require knowledge of costs related to the index hospitalization, post-discharge care, and readmissions. The goal of this study was to examine the impact of laparoscopic colectomy on discharge destination and 30-day readmission rates in younger (age:19-64 years) and older patients (age:65-90 years).
Methods: The study used the nationwide readmission database from 2013, the first nationally representative data on readmissions for patients of all ages. The cohort included adults undergoing elective colectomy: left hemicolectomy, right hemicolectomy, and sigmoidectomy. The outcomes were discharge destination for the index hospitalization (routine, skilled nursing facility [SNF]/ intermediate care facility [ICF], and home health care) and 30-day readmission rate. Multinomial logistic regression was conducted to determine the association of laparoscopic colectomy with discharge destination and multivariable logistic regression for 30-day readmission rates. An interaction between age and colectomy approach was included in determining the effect of laparoscopic colectomy by age on outcomes. Both models were risk-adjusted for age, gender, income, insurance status APR-DRG, Elixhauser comorbidities, hospital bed size, ownership and teaching status.
Results: Of 79,581 colectomy, 40.2% were laparoscopic. Laparoscopic colectomy was more frequent in younger patients (41.9% vs. 38.5%, p<0.0001). Laparoscopic patients were less likely to require additional post-discharge care compared to open colectomy: SNF/ICF (young, 1.3% vs. 7.0%; old, 11.0% vs. 31.0%); and home health (young, 6.0% vs. 23.8%; old, 6.1% vs. 25.1%). Laparoscopic colectomy had lower 30-day readmission rates in both age groups: younger (8.1% vs. 14.2%); and older (9.7% vs. 16.1%). In the risk-adjusted multinomial logistic model, the interaction between age and colectomy was significant for discharge destination. The laparoscopic approach had a more pronounced effect on SNF/ICF discharge location in younger patients (OR 0.35, 95% CI 0.30-0.41) compared to older patients (OR 0.43, 95% CI 0.40-0.46). Similar results were observed for home health discharge (young: OR 0.31, 95% CI 0.29-0.34, and old: OR 0.57, 95% CI 0.54-0.60). The risk-adjusted logistic model showed that laparoscopic colectomy the likelihood of 30-day readmissions in younger (OR 0.77, 95% CI 0.72-0.83) and older patients (OR 0.76, 95% CI, 0.71-0.81); the interaction term was not significant.
Conclusions: Laparoscopic colectomy offers the benefit of the lower level of post-discharge care for both younger and older patients, however regardless of technique age appears to be associated with a greater exposure to post-acute care costs and resource consumption.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78760
Program Number: P003
Presentation Session: Poster of Distinction (Non CME)
Presentation Type: PDIST