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BACKGROUND: Hospital readmission after major colorectal surgery is a major economic burden and a benchmark of quality care by government agencies. We hypothesized that a post-discharge telephone follow-up (TFU) could reduce readmission after abdominal colorectal surgery.

METHODS: Consecutive patients undergoing abdominal colorectal surgery over the 4-month period ending Oct 2016 were prospectively evaluated. A structured TFU call during the 4-day period after hospital discharge evaluating the patient’s clinical status and possible interventions to avoid readmission was conducted by a second-year medical student, supervised by two board certified colorectal surgeons. Readmission rates were compared to a control group undergoing abdominal colorectal surgery by the same surgeons not receiving TFU over the prior 12-month period. Low-complexity surgery was defined as small bowel resection, right colectomy, creation or revision of ileostomy or colostomy. High-complexity surgery included left or total colectomy, or proctectomy with or without diversion. Groups were compared using Fisher's exact test.

RESULTS: The TFU patient group (n=74) and control patient group (n=134) were well matched in all clinical and operative characteristics except for case complexity. TFU group patients were more likely to undergo low-complexity surgery (n=41;55%) compared to control group patients (n=35;26%) (p=0.001). Readmission rates in the TFU patient group (n=9; 12%) and control patient group (n=26; 19%) were comparable (p=.25). For patients undergoing high-complexity surgery, readmission rates were not statistically different between the TFU patients (n=6;18%) and control patients (n=14; 14%). For patients undergoing low-complexity surgery, readmission rates were significantly lower in the TFU patient group (n=3;7%) compared to the control patient group (n=12;34%) (p=0.004).

CONCLUSIONS: A simple, post discharge medical student-led phone call signficantly reduced the rate of readmission after low-complexity but not high-complexity colorectal surgery. Readmission after high-complexity colorectal surgery appears unpreventable. We recommend early post-discharge telephone follow-up to reduce readmission after abdominal colorectal surgery.

Available for download on Wednesday, August 01, 2018

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