Incidence and risk factors for unplanned readmission after colorectal surgery: A meta-analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
20
03
2023
accepted:
19
10
2023
medline:
20
11
2023
pubmed:
17
11
2023
entrez:
16
11
2023
Statut:
epublish
Résumé
Unplanned readmissions (URs) after colorectal surgery (CRS) are common, expensive, and result from failure to progress in postoperative recovery. These are considered preventable, although the true extent is yet to be defined. In addition, their successful prediction remains elusive due to significant heterogeneity in this field of research. This systematic review and meta-analysis of observational studies aimed to identify the clinically relevant predictors of UR after colorectal surgery. A systematic review was conducted using indexed sources (The Cochrane Database of Systematic Reviews, MEDLINE, and Embase) to search for published studies in English between 1996 and 2022. The search strategy returned 625 studies for screening of which, 150 were duplicates, and 305 were excluded for irrelevance. An additional 150 studies were excluded based on methodology and definition criteria. Twenty studies met the inclusion criteria and for the meta-analysis. Independent meta-extraction was conducted by multiple reviewers (JD & SR) in accordance with PRISMA guidelines. The primary outcome was defined as UR within 30 days of index discharge after colorectal surgery. Data were pooled using a random-effects model. Risk of bias was assessed using the Quality in Prognosis Studies tool. The reported 30-day UR rate ranged from 6% to 22.8%. Increased comorbidity was the strongest preoperative risk factor for UR (OR 1.39, 95% CI 1.28-1.51). Stoma formation was the strongest operative risk factor (OR 1.54, 95% CI 1.38-1.72). The occurrence of postoperative complications was the strongest postoperative and overall risk factor for UR (OR 3.03, 95% CI 1.21-7.61). Increased comorbidity, stoma formation, and postoperative complications are clinically relevant predictors of UR after CRS. These risk factors are readily identifiable before discharge and serve as clinically relevant targets for readmission risk-reducing strategies. Successful readmission prediction may facilitate the efficient allocation of healthcare resources.
Sections du résumé
BACKGROUND
BACKGROUND
Unplanned readmissions (URs) after colorectal surgery (CRS) are common, expensive, and result from failure to progress in postoperative recovery. These are considered preventable, although the true extent is yet to be defined. In addition, their successful prediction remains elusive due to significant heterogeneity in this field of research. This systematic review and meta-analysis of observational studies aimed to identify the clinically relevant predictors of UR after colorectal surgery.
METHODS
METHODS
A systematic review was conducted using indexed sources (The Cochrane Database of Systematic Reviews, MEDLINE, and Embase) to search for published studies in English between 1996 and 2022. The search strategy returned 625 studies for screening of which, 150 were duplicates, and 305 were excluded for irrelevance. An additional 150 studies were excluded based on methodology and definition criteria. Twenty studies met the inclusion criteria and for the meta-analysis. Independent meta-extraction was conducted by multiple reviewers (JD & SR) in accordance with PRISMA guidelines. The primary outcome was defined as UR within 30 days of index discharge after colorectal surgery. Data were pooled using a random-effects model. Risk of bias was assessed using the Quality in Prognosis Studies tool.
RESULTS
RESULTS
The reported 30-day UR rate ranged from 6% to 22.8%. Increased comorbidity was the strongest preoperative risk factor for UR (OR 1.39, 95% CI 1.28-1.51). Stoma formation was the strongest operative risk factor (OR 1.54, 95% CI 1.38-1.72). The occurrence of postoperative complications was the strongest postoperative and overall risk factor for UR (OR 3.03, 95% CI 1.21-7.61).
CONCLUSIONS
CONCLUSIONS
Increased comorbidity, stoma formation, and postoperative complications are clinically relevant predictors of UR after CRS. These risk factors are readily identifiable before discharge and serve as clinically relevant targets for readmission risk-reducing strategies. Successful readmission prediction may facilitate the efficient allocation of healthcare resources.
Identifiants
pubmed: 37972100
doi: 10.1371/journal.pone.0293806
pii: PONE-D-23-07960
pmc: PMC10653493
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0293806Informations de copyright
Copyright: © 2023 D’Souza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared no competing interests exist.
Références
Am J Surg. 2018 Apr;215(4):557-562
pubmed: 28760355
Eur J Surg Oncol. 2017 Jul;43(7):1312-1323
pubmed: 28342688
J Surg Res. 2016 Jan;200(1):200-7
pubmed: 26216748
J Am Geriatr Soc. 2013 Jul;61(7):1175-81
pubmed: 23730901
N Z Med J. 2009 Feb 13;122(1289):63-70
pubmed: 19305451
J Gastrointest Surg. 2021 Mar;25(3):795-808
pubmed: 32901424
Am J Surg. 2014 Mar;207(3):346-51; discussion 350-1
pubmed: 24439160
J Surg Res. 2018 Nov;231:234-241
pubmed: 30278934
Surg Endosc. 2020 Oct;34(10):4305-4314
pubmed: 31617097
N Engl J Med. 2009 Apr 2;360(14):1418-28
pubmed: 19339721
J Gastrointest Surg. 2014 Jan;18(1):35-43; discussion 43-4
pubmed: 24065366
Ann Intern Med. 2009 Feb 3;150(3):178-87
pubmed: 19189907
J Am Coll Surg. 2004 Jun;198(6):877-83
pubmed: 15194068
Colorectal Dis. 2011 Jul;13(7):816-22
pubmed: 20402737
Ann Surg. 2013 Jul;258(1):10-8
pubmed: 23579579
Ann Surg. 2013 Sep;258(3):430-9
pubmed: 24022435
Am Surg. 2016 May;82(5):433-8
pubmed: 27215725
Health Promot Pract. 2020 Jul;21(4):496-498
pubmed: 31874567
World J Surg. 2007 Nov;31(11):2138-43
pubmed: 17899252
Am J Surg. 2006 Mar;191(3):364-71
pubmed: 16490548
BMC Health Serv Res. 2012 Mar 26;12:77
pubmed: 22448728
Dis Colon Rectum. 2011 Nov;54(11):1362-7
pubmed: 21979179
JAMA Surg. 2014 Dec;149(12):1272-7
pubmed: 25337956
J Am Coll Surg. 2012 Apr;214(4):390-8; discussion 398-9
pubmed: 22289517
J Am Coll Surg. 2012 Sep;215(3):322-30
pubmed: 22726893
Open Med. 2009;3(3):e123-30
pubmed: 21603045
Ann Surg. 2016 Oct;264(4):621-31
pubmed: 27355263
Dis Colon Rectum. 2011 Dec;54(12):1475-9
pubmed: 22067174
J Geriatr Oncol. 2016 Nov;7(6):479-491
pubmed: 27338516
BMJ. 2019 Jan 30;364:k4597
pubmed: 30700442
J Surg Res. 2015 Feb;193(2):528-35
pubmed: 25438957
Ann Surg. 2010 Apr;251(4):659-69
pubmed: 20224370
J Am Coll Surg. 2014 Sep;219(3):552-69.e2
pubmed: 25067801
JAMA Surg. 2014 Apr;149(4):348-54
pubmed: 24522747
J Am Coll Surg. 2013 Aug;217(2):200-8
pubmed: 23870215
J Am Geriatr Soc. 2004 May;52(5):675-84
pubmed: 15086645
Dis Colon Rectum. 2015 Dec;58(12):1164-73
pubmed: 26544814
Dis Colon Rectum. 2014 Dec;57(12):1421-9
pubmed: 25380009
Adv Surg. 2014;48:185-99
pubmed: 25293615
Surgery. 2011 May;149(5):705-12
pubmed: 21397288
Arch Intern Med. 2006 Sep 25;166(17):1822-8
pubmed: 17000937
JAMA. 2015 Feb 3;313(5):512-3
pubmed: 25647207
J Am Coll Surg. 2018 Apr;226(4):382-390
pubmed: 29274835
JAMA. 2011 Oct 19;306(15):1688-98
pubmed: 22009101
Adv Surg. 2015;49:15-29
pubmed: 26299488
Ann Intern Med. 2011 Oct 18;155(8):520-8
pubmed: 22007045
BMC Cancer. 2014 Aug 23;14:607
pubmed: 25148902
J Am Coll Surg. 2013 Apr;216(4):756-62; discussion 762-3
pubmed: 23521958
Dis Colon Rectum. 2007 Sep;50(9):1316-23
pubmed: 17665252
Dis Colon Rectum. 2014 Dec;57(12):1371-8
pubmed: 25380002