Differences in outcome between patients readmitted to index versus non-index hospital trusts after colorectal resection.

BACKGROUND The clinical consequences of readmission following major surgery in the English National Health Service is unknown. This study aimed to determine differences in outcome between patients readmitted to index versus non-index trusts after major surgery. METHODS Adult patients who underwent colorectal resection in England in April 2006 to March 2017 were identified in the national Hospital Episodes Statistics dataset. Patients were included if they were readmitted as emergencies within 30 days of initial discharge. The primary outcome measure was all-cause mortality within 90-days of readmission. Comparisons between patients readmitted to index versus non-index trusts were adjusted for confounders using multivariable logistic regression. Rectal resection patients were a planned sub-group. RESULTS The readmission rate following colorectal resection was 15.1% (54680/364481), with 7.1% (3905/54680) readmitted to a non-index trust. The 90-day mortality following readmission was 7.1% (3874/54680) overall, and 3.9% (652/16736) in the rectal resection sub-group. The reoperation rate was 19.2% (10498/54680) overall, and 23.1% (3859/16736) after rectal resection. Mortality was significantly higher in non-index (10.9% [427/3905]) versus index trusts (6.8% [3447/50775], adjusted odds ratio 1.50, 95% confidence interval 1.34-1.68, p