A multicentre study to determine the incidence, demographics, aetiology and outcomes of 6-day emergency readmission following day-case endoscopy Sanchoy Sarkar a , Joe Geraghty a , Andrew R. Moore a , Simon Lal c , Jayapal Ramesh d , Keith Bodger b and CERT-N: Collaboration in Endoscopy, Research & Training-North-West Background Emergency readmission after elective procedures is a quality indicator of healthcare delivery, but data for endoscopy are limited. Objectives Using hospital episode statistics (HES) registration systems and a multicentre audit to describe outcomes of emergency readmission following elective endoscopy. Methods Emergency readmissions (April 2008–2009) within 6 days of an elective day-case upper-GI endoscopy (UE) and lower GI endoscopy (LE) were subjected to a multicentre retrospective audit (north-west of England) following the identification of cases from routinely coded hospital administrative data from HES. Results Of 29 868 day cases, there were 235 readmissions, of which 147 (63%) were endoscopy related. The overall endoscopy readmission rate was 0.5% and the highest for therapeutic UE (1.74%; P = 0.0001). The rates for therapeutic LE, diagnostic UE and LE were 0.6, 0.5 and 0.4%, respectively. The incidence of readmission was 0.2% because of cardiorespiratory event, 0.14% for symptoms and 0.08, 0.03, 0.02 and 0.016%, respectively, for bleeding, perforation, obstruction and nonrespiratory sepsis. Management was simple observation in 84.4%, intravenous antibiotics in 7.5%, surgery in 4.8% and repeat endoscopy in 2.7%. Although 24.5% were short-stay discharges, the mean hospital stay was 8.2 days. All-cause 30-day mortality was low at 0.06%, but was considerably higher in readmitted patients at 6.8% (P = 0.0001). Conclusion Novel insights into readmission rates can be gained following endoscopy using a combination of commercial analytical tools to examine HES data to identify eligible readmitted cases; multicentred patient-level audit readmission rates varied predictably across procedure types with cardiorespiratory events, the major cause. The risk of mortality in readmitted patients was significant. Eur J Gastroenterol Hepatol 24:1438–1446  c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2012, 24:1438–1446 Keywords: emergency readmission, endoscopic complications, endoscopic outcomes, mortality, quality, safety a Department of Gastroenterology, Royal Liverpool University Hospital, b Digestive Diseases Centre, University Hospital Aintree, Liverpool, c Department of Gastroenterology, Hope Hospital, Salford Royal Hospital, Salford and d Department of Gastroenterology, University Hospital of South Manchester, Manchester, UK Correspondence to Sanchoy Sarkar, PhD, MBChB, BSc(Hons), FRCP, Depart- ment of Gastroenterology, 5Z Link, Royal Liverpool University Hospital, Prescot Street, Liverpool L9 8XL, UK Tel: + 44 0151 706 3554; fax: + 44 0151 706 5832; e-mail: sanchoy@aol.com Received 4 May 2012 Accepted 14 July 2012 Introduction Readmission rates have long been proposed as an indicator of quality and as a surrogate marker of efficiency in healthcare [1–4]. In the UK, it has been shown to be an informative and valuable tool in assessing, examining and improving healthcare delivery for a number of reasons. First, it has shown significant institutional variability. Although the overall 30-day readmissions rate following the discharge of a nonelective care episode in England is 6.5%, the range is highly variable across the country from 0.5 to 10.5%, and cannot solely be explained by hospital case mix, hospital size and socioeconomic factors. Second, readmission rates have shown changes in trends over time. There is evidence that rates are increasing over time [5], which may instinctively be attributed to the ageing population. However, even within the elderly popula- tion (patients aged >75), there have been increasing trends, with an increase from 10% in 1998/1999 to 14% in 2006/2007. Third, readmissions data have been proven to be effective as an indicator of quality for chronic disease management such as chronic obstructive pulmonary disease and congestive cardiac failure. Fourth, it has been shown to have an association with unfavourable clinical outcomes such as in colorectal surgery [6]. Finally, in terms of costs, it has been estimated that readmissions cost the Nation Health Service (NHS) around £1.6 billion/year [7]. Consequently, readmissions following either an emergency hospital episode or an elective surgery are centrally monitored for all NHS trusts with defined ‘acceptable’ targets, with financial penalties attached for poor performance. There is, however, limited information for emergency readmission after day-case interventions [8,9], and 1438 Original article 0954-691X  c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0b013e3283582db0 Copyright © Lippincott Williams & Wilkins. 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