The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis

Merath, Katiuscha; Bagante, Fabio; Chen, Qinyu; Beal, Eliza W.; Akgül, Özgür; Idrees, Jay J.; Dillhoff, Mary; Cloyd, Jordan M.; Schmidt, Carl; Pawlik, Timothy M.

doi:10.1007/s11605-018-3783-0

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…In patients who underwent major and minor liver resection, the median hospital stays were 9 and 7 days, respectively, and 30-day readmission rates were 17.8% and 7%, respectively. These numbers are comparable with registry data on hepatopancreatobiliary surgery from the United States, where 7-day hospital stays and 17% readmission rates were reported (27). In all, 30.1% of minor pancreatic resections were done in a minimally invasive manner, a notably high rate taking into account that the first laparoscopic pancreatic resection was done at our center in 2007.…”

Section: Discussionsupporting

confidence: 85%

Critical evaluation of quality of hepatopancreatic surgery in a medium-volume center in Finland using the Accordion Severity Grading System and the Postoperative Morbidity Index

Tahkola

Väyrynen

Kellokumpu

et al. 2020

J Gastrointest Oncol

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Background: Hepatopancreatobiliary surgery is prone to complications. Methods are needed to monitor surgical outcomes and enable comparison between institutions. Methods: Complications were collected prospectively and reviewed using the modified Accordion SeverityGrading System (MASGS) and the Postoperative Morbidity Index (PMI). Results: This study included 527 consecutive patients receiving either pancreatic or liver resection in 2000-2017 in Central Finland Central Hospital. The PMI was 0.177 for all patients, and 0.192, 0.094, 0.285, and 0.129 for patients receiving major pancreatic (n=218), minor pancreatic (n=93), major liver (n=73), and minor liver (n=143) resection, respectively. The rates of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomies (n=200) were 6.5% for grade B and 5.5% for grade C; rates for biliary leak were 1.0% (grade A), 2.5% (grade B), and 0.5% (grade C). Similarly, the rates for delayed gastric emptying (DGE) were 2.8% (grade A), 15.6% (grade B), and 3.7% (grade C). Postoperative hepatic dysfunction occurred in 2.3%, major surgical site bleeding in 2.3%, and biloma in 7.9% of patients after liver resection. Ninety-day mortality rates were 3.7% and 1.1% in major and minor pancreatic resections, and 8.2% and 0.7% in major and minor liver resections. Major complications occurred in 13.3% and 3.3% in pancreatic, and 19.2% and 6.3% in liver resections, respectively. Conclusions: Major pancreatic and hepatic surgery are associated with significant morbidity and burden in our center, comparable with previous population-based studies. PMI is an informative way to monitor surgical outcomes and enable comparison between institutions.

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Section: Discussionsupporting

confidence: 85%

Critical evaluation of quality of hepatopancreatic surgery in a medium-volume center in Finland using the Accordion Severity Grading System and the Postoperative Morbidity Index

Tahkola

Väyrynen

Kellokumpu

et al. 2020

J Gastrointest Oncol

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“…Examining data obtained from the Surveillance, Epidemiology, and End Results-Medicare linked database, Stitzenberg et al 29 reported that roughly 13%-15% of patients who had a range of cancer operations were discharged to a SNF. In a separate study that focused only on patients who underwent hepatopancreatobiliary surgery, Merath et al 30 noted that approximately 5%-6% of patients had a postdischarge admission to a SNF. In the current study, the utilization of a SNF was much greater at 17%.…”

Section: Discussionmentioning

confidence: 99%

“…The reason for the greater incidence of SNF utilization in the current study was undoubtedly multifactorial and likely related to differences in the underlying patient cohort. For example, unlike the study by Merath et al 30 that included patients of all ages who underwent either liver or pancreatic procedures, the current study included only patients who were 65 years of age or older and had undergone pancreatic resection. The older patient cohort, as well as the focus on pancreatic procedures that can be associated with complications, such as fistula and delayed gastric emptying, likely explain the greater SNF utilization in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery

Paredes

Hyer

Beal

et al. 2019

Surgery

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a b s t r a c tBackground: Data on skilled nursing facility utilization among patients undergoing pancreatic surgery remain scarce. We sought to define the incidence of utilization of skilled nursing facilities and determine the impact of skilled nursing facility quality markers on postoperative outcomes among patients who underwent pancreatic surgery. Methods: Medicare Standard Analytic Files were used to identify patients who underwent pancreatic resection during 2013-2015. Nursing Home Compare datasets were used to examine the influence of skilled nursing facility quality as estimated by quality markers (Medicare star ratings) on postoperative outcomes. Results: Among 13,018 patients who underwent pancreatectomy, 2,247 (17.3%) were discharged to a skilled nursing facility. Compared with patients discharged home, patients discharged to a skilled nursing facility were older (median age: 72 [interquartile range 68-76] vs 76 [interquartile range 71-80]), more likely female (44.4% vs 56.8%), and had greater Charlson comorbidity index scores (median score: 3 [interquartile range 2-8] vs 4 [interquartile range 2-8]) (all P < .001). Most patients were discharged to an above-average skilled nursing facility ( N = 1,463, 65.1%), and a lesser subset was discharged to a skilled nursing facility with a below-average ( N = 490, 21.8%) or average ( N = 294, 13.1%) star rating. The 30-day hospital readmission was greatest among patients discharged to a below-average skilled nursing facility (below average N = 217, 44.3%; average N = 110, 37.4%; above average N = 517, 35.3%; P = .002). On multivariate analysis, patients discharged to below-average skilled nursing facilities remained 64% more likely to be readmitted within 30 days (OR 1.64, 1.29-2.02, P < .001). In contrast, 30-day mortality was comparable across the skilled nursing facility star rating categories ( P = .08). Conclusion: Roughly 1 in 6 patients undergoing pancreatic surgery were discharged to a skilled nursing facility. Patients discharged to a below-average skilled nursing facility were more likely to be readmitted compared with patients discharged to an above-average skilled nursing facility.

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“…1 Although the analysis of individual outcome measures, such as mortality, morbidity, length of stay (LOS), and readmission, has advantages, composite benchmarks of surgical quality may be more relevant and helpful. [2][3][4][5][6][7][8] In particular, data on a single indicator do not reflect the whole surgical process and may not reliably measure overall hospital quality. [9][10][11][12] Composite measures combine information from multiple domains into a single summary measure and therefore may be superior to individual measures for the analysis of hospital performance.…”

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confidence: 99%

A Multi-institutional International Analysis of Textbook Outcomes Among Patients Undergoing Curative-Intent Resection of Intrahepatic Cholangiocarcinoma

et al. 2019

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IMPORTANCE Composite measures may be superior to individual measures for the analysis of hospital performance and quality of surgical care.OBJECTIVE To determine the incidence of a so-called textbook outcome, a composite measure of the quality of surgical care, among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma. DESIGN, SETTING, AND PARTICIPANTSThis cohort study involved an analysis of a multinational, multi-institutional cohort of patient from 15 major hepatobiliary centers in North America, Europe, Australia, and Asia who underwent curative-intent resection of intrahepatic cholangiocarcinoma between 1993 and 2015. Data analysis was conducted from April 2018 to May 2018. MAIN OUTCOMES AND MEASURESHospital variation in the composite end point of textbook outcome, defined as negative margins, no perioperative transfusion, no postoperative surgical complications, no prolonged length of stay, no 30-day readmissions, and no 30-day mortality. Secondary end points were factors associated with achieving textbook outcomes. RESULTS Among 687 patients (of whom 370 [53.9%] were men; median patient age, 61 [range, 18-86] years) undergoing curative-intent resection of intrahepatic cholangiocarcinoma, a textbook outcome was achieved in 175 patients (25.5%). Being 60 years or younger (odds ratio [OR], 1.61 [95% CI, 1.04-2.49]; P = .03), absence of preoperative jaundice (OR, 4.40 [95% CI, 1.28-15.15]; P = .02), no neoadjuvant chemotherapy (OR, 2.57 [95% CI, 1.05-6.29]; P = .04), T1a/T1b-stage disease (OR, 1.58 [95% CI, 1.01-2.49]; P = .049), N0 status (OR, 3.89 [95% CI,]; P = .001), and no bile duct resection (OR, 2.46 [95% CI,; P = .009) were independently associated with achieving a textbook outcome after resection. A prolonged length of stay had the greatest negative association with a textbook outcome. A nomogram to assess the probability of textbook outcome was developed and had good accuracy in both the training data set (area under the curve, 0.755) and validation data set (area under the curve, 0.763). CONCLUSIONS AND RELEVANCEIn this study, while hepatic resection for intrahepatic cholangiocarcinoma was performed with less than 5% mortality in specialized centers, a textbook outcome was achieved in only approximately 26% of patients. A textbook outcome may be useful for the reporting of patient-level hospital performance and hospital variation, leading to quality improvement efforts after resection of intrahepatic cholangiocarcinoma.

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The Impact of Discharge Timing on Readmission Following Hepatopancreatobiliary Surgery: a Nationwide Readmission Database Analysis

Cited by 14 publications

References 35 publications

Critical evaluation of quality of hepatopancreatic surgery in a medium-volume center in Finland using the Accordion Severity Grading System and the Postoperative Morbidity Index

Critical evaluation of quality of hepatopancreatic surgery in a medium-volume center in Finland using the Accordion Severity Grading System and the Postoperative Morbidity Index

Impact of skilled nursing facility quality on postoperative outcomes after pancreatic surgery

A Multi-institutional International Analysis of Textbook Outcomes Among Patients Undergoing Curative-Intent Resection of Intrahepatic Cholangiocarcinoma

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