Postsurgery readmission rates questioned as a quality measure in colorectal cancer care

No significant variation was found in hospital readmission rates after colorectal cancer surgery when the data was adjusted to account for patient characteristics, coexisting illnesses, and operation types. This study's findings may prompt questions about the use of readmission rates as a measure of hospital quality.

Hospital readmission after surgery can be common, and it results in an increased cost of care. The Centers for Medicare and Medicaid Services (CMS) has focused on reducing unplanned hospital readmissions, and hospitals are penalized in reimbursement if there are excess readmissions for certain diagnoses.

The authors, from the Walter Reed National Military Medical Center, in Bethesda, Maryland, and Johns Hopkins University School of Medicine, in Baltimore, examined whether readmission rates vary among hospitals. They used data from 44,822 patients who underwent colorectal cancer surgery at 1,401 US hospitals from 1997 through 2002.

The overall 30-day readmission rate was 12.3%. In hospitals that performed at least five operations annually, there was marked variation in raw readmission rates with a range from 0% to 41.2%. But when the data was adjusted to account for patient characteristics, coexisting illnesses, and operation types, no significant variability remained in readmission rates, which ranged from 11.3% to 13.2%.

"These data have important implications because they strongly suggest that minimal risk-adjusted variation exists in hospital readmission rates after colorectal surgery," stated the authors. They went on to say that the CMS Hospital Compare web site does not use confidence intervals at all, and that this is statistically questionable and problematic, “especially given the substantial financial penalties involved.”

The authors also stated, “The use of readmission rates as a high-stakes quality measure for payment adjustment or public reporting across surgical specialties should proceed cautiously and must include appropriate risk adjustment.”

The study was published in JAMA Surgery (2014; doi:10.1001/jamasurg.2014.988).

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