30-day Readmission After Pancreatic Resection

Fisher, Alan E.; Fernandes‐Taylor, Sara; Campbell-Flohr, Stephanie A.; Clarkson, Sam; Winslow, Emily R.; Abbott, Daniel E.; Weber, Sharon M.

doi:10.1097/sla.0000000000002230

Cited by 40 publications

(10 citation statements)

References 27 publications

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“…There has also been little progress in preventing common and often costly post-PD complications. Meta-analysis and multi-institutional studies demonstrate that infectious complications, failure to thrive, DGE, and complication severity drive readmission 13 , 14 , 17 , 18 and therefore represent cost saving opportunities. 5 , 8 Despite this knowledge, there has been little progress in the preventing or improving treatment of the most common post-PD complications.…”

Section: Discussionmentioning

confidence: 99%

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Acher

Barrett

Schwartz

et al. 2021

Journal of Gastrointestinal Surgery

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Introduction Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients. Methods Hospital cost data from date of discharge to postoperative day 90 were merged with 2008-2018 NSQIP data. Early readmission was within 30 days of surgery, and late readmission was 30 to 90 days from surgery. Regression analyses for readmission controlled for patient comorbidities, complications, and surgeon. Results Of 230 patients included, 58 (25%) were readmitted.

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Section: Discussionmentioning

confidence: 99%

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Acher

Barrett

Schwartz

et al. 2021

Journal of Gastrointestinal Surgery

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“…Statistical synthesis is expected to solve this issue 40. However, pooling multivariate data can be misleading as adjusted variables and the final model will be diverse between studies 41. Besides, prognostic factors will be determined based on statistically significant results and the consistency of findings.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for acute exacerbation of idiopathic pulmonary fibrosis: protocol for a systematic review and meta-analysis

Kamiya

Panlaqui

2019

BMJ Open

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IntroductionIdiopathic pulmonary fibrosis (IPF) is a form of chronic fibrosing interstitial pneumonia with unknown disease aetiology. Acute exacerbation (AE) of IPF is an accelerated disease progression beyond its expected course. A 30-day mortality of AE of IPF is 40%. While death may occur, there is much variation in the clinical progression of this condition. Previous attempts have been made to investigate various possible prognostic factors for AE of IPF; however, they have yet to be confirmed. The aim of this systematic review is to clarify these prognostic factors.Methods and analysisIn this review, AE of IPF is the condition of interest, which has been defined according to previously established diagnostic criteria. The primary outcomes of interest include short-term all-cause mortality and pulmonary-cause mortality. The secondary outcomes of interest include long-term mortality and hospital separation for the disease. Primary studies investigating prognostic factors for AE of IPF are eligible for inclusion in this review. All study types are permitted except case reports. Two reviewers will search electronic databases, such as Medline and EMBASE, from 2002 to the 1 April 2019 and extract data independently. Risk of bias in individual studies will be assessed using the Quality in Prognostic Studies tool. Meta-analysis will be conducted for univariate data if at least three studies report the effect of a specific prognostic factor using similar statistical methods. Multivariate results will be reported qualitatively. Subgroup analysis and sensitivity analysis will be considered with the aim of generalising findings to the clinical settings and drawing more robust conclusions. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method will be applied to evaluate the quality of evidence for each prognostic factor.Ethics and disseminationEthical approval will not be required. Results will be reported in a peer-reviewed scientific journal.PROSPERO registration number CRD42018106172

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“…Hospital-level risk factors included hospital bed count, hospital cancer discharge volume, hospital pancreatic cancer discharge volume, hospital pancreatic surgery volume, hospital location, and hospital ownership (e.g., nonprofit). The effect of hospital size on readmission was inconsistent in the existing literature; thus, we aimed to understand whether hospital size has an impact on readmission by using four different measures representing hospital size [5]. Hospital bed count was calculated within NRD data.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have investigated this topic, but variations existed in approach. Studies differed in the time frame used for readmission, the definition of risk factors, surgery types, and the data source [5]. Not surprisingly, the results of these studies were also different, with reported readmission rates ranging from 6% to 59% [6, 7].…”

Section: Introductionmentioning

confidence: 99%

“…Not surprisingly, the results of these studies were also different, with reported readmission rates ranging from 6% to 59% [6, 7]. Discrepancy also existed in the reasons and the risk factors for readmission [5]. While some studies found patient-level risk factors contribute most to the readmissions [8], others found hospital surgery volume had a significant impact not only on the readmissions but also on other postoperative outcomes [9].…”

Section: Introductionmentioning

confidence: 99%

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Readmissions after Pancreatic Surgery in Patients with Pancreatic Cancer: Does Hospital Variation Exist for Quality Measurement?

Wang

Brown

2019

Visc Med

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Background: The appropriateness of using readmission rate after pancreatic surgery among pancreatic cancer patients as a quality metric to evaluate hospital performance has been widely discussed in the literature. Objectives: The present study reported readmission rate using Nationwide Readmissions Database (NRD), examined the reasons and risk factors for readmissions, and evaluated the appropriateness of using it as a quality metric. Method: We analyzed 3,619 patient discharge records in 2014. The outcome of interest was all-cause 30-day readmission. Reasons for readmission were grouped into clinical associated categories. Hierarchical regression model was used for examining the relationship between risk factors and readmission. Results: The 30-day readmission rate was 20.95%. The most common reason for readmission was surgery-related complication. In descriptive analyses, age, certain comorbidities, number of chronic conditions, mortality risk, severity of illness, living at large metropolitan area, resident of the state where patients received initial care, postoperative complication, length of stay, discharge location, and receiving care at the hospitals in large metropolitan area were predictive of readmission. In multivariable analysis, age, depression, peripheral vascular disorder, mortality risk, and discharge location were independently associated with readmission. The intraclass correlation coefficient was 0.41 for hierarchical regression model. Conclusions: Readmission after pancreatic surgery remains an important issue. Our study found the majority of variation in readmissions is accounted for by patient factors whereas there was little between hospital variation. This finding does not support the use of readmission rate after pancreatic surgery as a quality metric.

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30-day Readmission After Pancreatic Resection

Abstract: Readmission after pancreatic resection is common and can largely be attributed to infectious complications and inability to maintain adequate hydration and nutrition. Focus on outpatient resources and follow-up to address these issues will prove valuable in reducing readmissions.

Cited by 40 publications

References 27 publications

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation

Prognostic factors for acute exacerbation of idiopathic pulmonary fibrosis: protocol for a systematic review and meta-analysis

Readmissions after Pancreatic Surgery in Patients with Pancreatic Cancer: Does Hospital Variation Exist for Quality Measurement?

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