Measures of patient experience are now widely accepted as core components of health care quality.^1,2 Accordingly, the Centers for Medicare and Medicaid Services (CMS) now measure and publicly report patient satisfaction using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.³ New CMS payment strategies likewise aim to encourage high-value care by attaching a percentage of hospital reimbursement to performance on various quality measures relating to clinical processes of care, certain risk-adjusted outcomes, efficiency, and patient experience of care.⁴ In 2015, 30% of a hospital’s weighted performance score was based on measures of patient experience, thereby creating a strong incentive for hospitals to deliver care that is patient centered.⁵

The use of post-acute care is common among the elderly and accounts for $62 billion in annual Medicare expenditures. However, little is known about post-acute care use after surgery. Data were merged between the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and Medicare claims for 2005 to 2008. Post-acute care use, including skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and home health care (HHC) were analyzed for 3 operations: colectomy, pancreatectomy, and open abdominal aortic aneurysm repair. Controlling for both preoperative risk factors and the occurrence of postoperative complications, we used multinomial logistic regression to estimate the odds of use for each type of post-acute care after elective surgery compared with home discharge. Post-acute care was used frequently for patients undergoing colectomy (40.0%; total n=10,932), pancreatectomy (46.0%; total n=2,144), and open abdominal aortic aneurysm (AAA) repair (44.9%; total n=1,736). Home health was the most frequently reported post-acute care service for each operation (range 23.2% to 31.5%) followed by SNF (range 12.0% to 15.0%), and then by IRF (range 2.5% to 5.4%). The majority of patients with at least 1 inpatient complication were discharged to post-acute care (range 58.6% for open AAA repair to 64.4% for colectomy). In multivariable analysis, specific preoperative risk factors, including advanced age, poor functional status, and inpatient complications were significantly associated with increased risk-adjusted odds of discharge to post-acute care for each operation studied. Among elderly patients, post-acute care use is frequent after surgery and is significantly associated with several preoperative risk factors and postoperative inpatient complications. Further work is needed to ensure that post-acute care services are used appropriately and cost-effectively.

Reducing hospital readmissions after discharge is a pivotal component of the quality improvement and cost-containment measures in the Patient Protection and Affordable Care Act.¹ Readmission rates for certain medical conditions are now publically reportable outcomes, and readmissions after certain surgical procedures are soon to follow suit.^2,3 In anticipation, the Centers for Medicare & Medicaid Services (CMS) sponsored the development of a standardized measure to evaluate hospital readmissions for any cause.⁴ Quiz Ref ID The Hospital-Wide All-Cause Unplanned Readmission Measure, which is yet to be implemented, uses Medicare claims data to calculate a hospital-level, risk-standardized rate of all unplanned readmissions within 30 days of discharge. This rate will be used to compare hospital performance and penalize those hospitals with higher-than-expected readmission rates.

Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20–30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role. However, resection remains a core tenet of management, serving as the gold standard for a curative-intent therapy. As such, the input of a dedicated hepatobiliary surgeon is paramount for appropriate patient selection and choice of surgical approach, as significant advances in the field have made management decisions extremely nuanced and complex. We herein aim to review the contemporary surgical management of colorectal liver metastasis with respect to both perioperative and operative considerations.