Causes and Rates of 30-day Readmissions after Percutaneous Transhepatic Biliary Drainage Procedure

Abstract

To investigate rates and causes of 30-day readmission for patients who undergo percutaneous transhepatic biliary drainage (PTBD) procedures. Materials and Methods: In this retrospective study, PTBD procedures performed at a tertiary care institution (June 2008 to May 2013) were reviewed. For each patient, the first 30-day readmission was used to determine cause of readmission. Two interventional radiologists independently categorized causes for readmission as planned or unplanned, and unplanned causes as related to or unrelated to interventional radiology. Interventional radiology-related readmissions were categorized as potentially preventable or unpreventable. Factors associated with higher odds for 30-day readmission were identified with univariable and multivariable analysis. Results: There were 266 procedures in 266 patients (mean age, 67 years; interquartile range, 57-76 years; 53.4% men). The cause of obstruction was malignant in 50.0% of patients (133 of 266). There were 122 of 266 patients (45.9%) readmitted within 30 days. Of these readmissions, 44 of 122 (36.1%) were planned and 78 of 122 (63.9%) were unplanned. A majority of unplanned readmissions (57 of 78; 73%) were related to interventional radiology. Of unplanned interventional radiology-related readmissions, 16% (nine of 57) were related to periprocedural complications and 51% (29 of 57) were considered preventable. At multivariable analysis, Medicaid insurance (odds ratio, 3.68; 95% confidence interval: 1.52, 9.99; P = .009) and bilateral PTBDs (odds ratio, 5.81; 95% confidence interval: 1.79, 18.90; P = .003) were associated with 30-day readmission. Conclusion: Thirty-day readmissions after primary biliary drainage are common and a majority of unplanned readmissions are drainrelated. Nearly half of unplanned interventional radiology-related readmissions are potentially preventable.

Society of Interventional Radiology Quality Improvement Standards for Percutaneous Cholecystostomy and Percutaneous Transhepatic Biliary Interventions

“…The 30-day readmission rate after percutaneous transhepatic biliary drainage has been reported at 45.9%, with 51% of these events deemed preventable. Drainage catheter malfunction represents the cause of the vast majority of these admissions (99). Several authors have suggested that adverse events related to internal/external tubes as a result of inadequate bile flow and tube dislodgment (sepsis and hemorrhage) can be minimized by placing a self-retaining tube of at least 10 F through the ampulla or anastomosis (25,35,91).…”

“…Biliary catheters are typically secured to the skin using nonabsorbable suture or adhesive devices, but despite these efforts to secure them, displacement or dislodgment can occur. One third of preventable readmissions with biliary drains were due to catheter care immediately after placement with subsequent catheter malfunction (99). The incidence of accidental removal has been reported in 3% of cases and up to 9% of cases in the acute care setting (106).…”

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

“…SOP procedures, however, are not without disadvantage themselves. Percutaneous transhepatic approaches can sometimes be unfeasible in patients with ascites and can put patients at risk of external catheter dislodgement as well as bleeding, particularly in patients with coagulopathies . Those patients with prolonged external drainage are at risk for dehydration, malabsorption, and electrolyte disturbances due to loss of biliary contents .…”

“…be unfeasible in patients with ascites and can put patients at risk of external catheter dislodgement as well as bleeding, particularly in patients with coagulopathies. [21][22][23][24] Those patients with prolonged external drainage are at risk for dehydration, malabsorption, and electrolyte disturbances due to loss of biliary contents. 21,22 Selection of appropriate patients would thus be necessary for SOP procedures to achieve maximal benefit.…”

Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?

“…A retrospective study of more than 2000 PTBD procedures in 385 patients reported that 40% of patients presented at least one drainage-related AE, with malignant disease being a risk factor for drainage occlusion and cholangitis[18]. A recent retrospective study from Sarwar and co-workers on 266 PTBD procedures in 266 patients reported a 45.9% of readmission at 30 d, 63.9% of which were unplanned[22]. The high rate of AE and readmissions, in addition to the presence of the external drainage, could heavily impair the patient’s quality of life and, at the same time, significantly increases the costs.…”