Factors affecting readmission rates after pancreatectomy

Abstract

Background Pancreatectomy is a complex operation with a historic readmission rate of approximately 20%. Hospital readmissions lead to increased patient and health system costs, morbidity, and mortality making them a topic of great interest. The objective of this study was to identify factors associated with readmission after pancreatectomy in order to target areas for improvement. Methods Pancreatectomy procedures for malignancy in adults from 2005 to 2011 were identified in the California State Inpatient Database. Descriptive analysis was conducted to evaluate the association between baseline variables and readmission status. Logistic regression models were developed to determine whether the bivariate associations identified persisted after adjusting for patient characteristics. Results Of the 4262 patients who underwent a pancreatectomy, 843 (19.8%) were readmitted within 30 days. Readmission rates by year did not vary over the study period. Results from multivariable analysis showed that males, Hispanics, Medicare recipients, patients with an initial length of stay >11 days, patients who were discharged to a skilled nursing facility, and those with chronic anemia were more likely to be readmitted compared to those without these characteristics. The majority of readmissions occurred within 15 days after discharge. Conclusions Readmissions after pancreatectomy are multifactorial. Preoperative optimization, minimizing postoperative complications, and assuring patients have been evaluated by a multidisciplinary team may reduce the readmission rate.

Feasibility and Safety of a “Shared Care” Model in Complex Hepatopancreatobiliary Surgery

“…For example, a PD perioperative mortality rate of 1.1% and a readmission rate of 13.2% in our series compare favorably to the NSQIP collaborative (1.9% and 20.6%, respectively) and to rates reported in the literature (<5% and 20%, respectively) 26,27 . Similarly, other morbidity measures in this series, including unplanned reoperation, postoperative sepsis, and postoperative transfusion, are also in keeping with the NSQIP collaborative and literature 28–31 . Two pancreatectomy-specific outcomes do call for attention.…”

“…26,27 Similarly, other morbidity measures in this series, including unplanned reoperation, postoperative sepsis, and postoperative transfusion, are also in keeping with the NSQIP collaborative and literature. [28][29][30][31] Two pancreatectomy-specific outcomes do call for attention. A grade B pancreatic fistula rate of 25.2% is toward the higher end of traditionally cited rates (9.5%-28.5%), and higher than the NSQIP collaborative rate of 12.1%.…”

The Implications of Readmission on Cost and Patient Outcomes Following Distal Pancreatectomy and Splenectomy

“…13 There is consistent literature showing that the robotic approach to distal pancreatectomy and splenectomy is not the cause of readmission. 14,15 This study was undertaken with an expanded number of patients with expanded follow-up to previously reported experience. Additionally, this study denotes the costs that readmitted patients incur, which has not previously been a point of study.…”

Quality performance indicators for hepato-pancreatico-biliary procedures: a systematic review

“…Simple outcome measures such as intensive care day stay, hospital day stay, mortality, morbidity, transfusion rates, and reintervention rates are widely reported but may vary with jurisdiction, organizational culture, and patient population. 3,4 Similarly, pathological parameters such as total nodal retrieval rate and margin status have been proposed but these are often reliant on sound and standardized pathological examination as well as surgical expertise, 5 and achieving an unsatisfactory result may not always reflect a poorly performed operation.…”