Readmission Rates, Colorectal Surgery and Reporting

The website Outpatient Surgery featured a story about a paper from Johns Hopkins that showed almost 25% of privately insured patients undergoing colorectal surgery are readmitted within 90 days. The paper appeared in the December, 2011 issue of Diseases of the Colon and Rectum.

The story highlighted several elements of the paper including the cost of readmission, averaging about $8800 and the role of surgical site infection as a major factor.

The report about the paper fails to mention the important limitations of the study. The research was based on commercial insurance claims, not hospital charts, and some clinical information could not be obtained. Also, the number of planned readmissions, such as those for elective closure of a colostomy after emergency surgery, could not be ascertained from the database.

The Outpatient Surgery article ends with the following:

Here's how you can reduce readmissions: 

Have nurses review patients' discharge plans before they leave, make follow-up appointments and review medication lists, tasks shown to prevent some return visits to the emergency department for minor concerns.

Have nurses follow up with patients by phone in the days after discharge. Those deemed at high risk for readmission should receive home visits from a nurse.

The only problem is that nowhere in the study do the authors state that the above interventions “can reduce readmissions.” What they do say is that such actions may be of use. But their research was retrospective and simply documented the problem of readmissions. The study was not designed to test whether nurses helping to plan discharges or telephoning patients can prevent readmissions.

Bottom line: Reporters who write about research studies should be careful about what conclusions they attribute to the authors.