National Trends in Readmission and Resource Utilization After Pancreatectomy in the United States

Aguayo, Esteban; Antonios, James; Sanaiha, Yas; Dobaria, Vishal; Sareh, Sohail; Huynh, Ashley; Benharash, Peyman; King, Jonathan C.

doi:10.1016/j.jss.2020.04.037

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…Previous studies have shown that postoperative nutritional imbalance was associated with the postoperative death of approximately 10% of pancreatic cancer patients [7,8]. Further, inadequate nutritional intake was found to be asso-ciated with increased stress response, slow wound healing, and high postoperative infection rates, which could lead to higher risks for readmission [9,10].…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Readmission of Patients with Pancreatic Cancer after Surgery

Zhou

Han

2022

Applied Bionics and Biomechanics

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Objective. Pancreatic cancer is one of the deadliest solid malignancies. Its surgical resection is technically very challenging and has a high risk of complications even after discharge. This study analyzed the risk factors associated with unplanned readmission after pancreatic cancer surgery. Methods. Pancreatic cancer patients who were readmitted within 30 days after surgery were classified as the observation group, while those not readmitted within 30 days postsurgery were classified as the control group. The serum levels of gastrointestinal hormones, stress hormones, and peripheral immune cells of the two groups were compared at different intervals. Results. No significant differences in gender and age were observed between the two groups. At 7, 14, and 21 days postsurgery, the levels of gastrointestinal hormones motilin, gastrin, calcitonin gene-related peptide, and growth hormone-releasing peptide of the observation group were lower than the control group, while the levels of adrenocorticotropin, renin, angiotensin, and plasma aldosterone of the observation group were significantly higher than the control group. In addition, compared to the control group, lower levels of CD4+T cells, CD8+T cells, and NKT cells and higher levels of Treg, Breg, and MDSC cells were observed in the peripheral blood of the observation group. Conclusion. The serum levels of gastrointestinal hormones, stress hormones, and peripheral immune cells could be associated with the risk of unplanned readmission within 30 days after pancreatic cancer surgery.

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Section: Introductionmentioning

confidence: 99%

Factors Affecting the Readmission of Patients with Pancreatic Cancer after Surgery

Zhou

Han

2022

Applied Bionics and Biomechanics

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“…The hospital and surgical volume is known to be associated with the risk of complication in pancreatic surgery [20,21]. The institution that conducted present study is a high-volume center performing more than 500 cases of pancreatic surgery per year and there may be differences in the rate of complication from low volume center.…”

Section: Discussionmentioning

confidence: 99%

Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm

Lee

Park

Hwang

et al. 2020

JCM

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Objective: To propose a decision tool considering both malignancy probability and surgical risk for intraductal papillary mucinous neoplasm (IPMN). Background Data Summary: Surgical risk and malignancy probability are both critical factors in making decisions about surgical resection of IPMN. Methods: We included 800 patients who underwent pancreatic resection for branch duct and mixed-type IPMN (April 1995 to June 2018). A nomogram was used to obtain the malignancy probability (MP-N). The surgical risks were estimated as the postoperative complication rate and serious complication from the ACS NSQIP surgical risk calculator (SC-ACS NSQIP). The risk–benefit analysis was conducted in two ways: calculation of the cutoff value of MP-N using the complication rate and directly comparing the MP-N and SC-ACS NSQIP results. Results: The optimal cutoff value of MP-N was 32% and 21% in the pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) groups, respectively, when using the major complication rate (Clavien grades III over). When we applied the optimal cutoff value to the two surgical methods, surgery was reduced by 51.7% in the PD group and 56% in the DP group, and the AUC value of the malignant predictions were 0.7126 and 0.7615, respectively. According to the direct comparison of MP-N and SC-ACS NSQIP, surgery was reduced by 31.7%, and the AUC value of malignant prediction was 0.6588. Conclusion: Our risk–benefit analysis model considering both malignancy probability and surgical risk is relatively acceptable, and it may help surgeons and patients make treatment decisions for a disease with a broad spectrum of malignancy rates.

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“…The Agency of Healthcare Research and Quality (AHRQ) supports HCUP via a Federal–State–Industry partnership. Data from the NRD are generated annually and contains approximately 57.8% of all-age, all-payer discharges across 28 geographically separated states in the US [ 21 ]. The NRD provides International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).…”

Section: Methodsmentioning

confidence: 99%

Association between Metabolic Obesity Phenotypes and the Burden of Hospitalized Postmenopausal Patients Concomitant with Osteoporosis: A Retrospective Cohort Study Based on the National Readmission Database

Jiang

Yuan

et al. 2023

JCM

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Background: The present definition of obesity based on body mass index (BMI) is not accurate and effective enough to identify hospitalized patients with a heavier burden, especially for postmenopausal hospitalized patients concomitant with osteoporosis. The link between common concomitant disorders of major chronic diseases such as osteoporosis, obesity, and metabolic syndrome (MS) remains unclear. Here, we aim to evaluate the impact of different metabolic obesity phenotypes on the burden of postmenopausal hospitalized patients concomitant with osteoporosis in view of unplanned readmissions. Methods: Data was acquired from the National Readmission Database 2018. The study population was classified into metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) patients. We estimated the associations between metabolic obesity phenotypes and 30- and 90-day unplanned readmissions. A multivariate Cox Proportional Hazards (PH) model was used to assess the effect of factors on endpoints, with results expressed as HR and 95% CI. Results: The 30-day and 90-day readmission rates for the MUNO and MUO phenotypes were higher than that of the MHNO group (all p < 0.05), whereas no significant difference was found between the MHNO and MHO groups. For 30-day readmissions, MUNO raised the risk mildly (hazard ratio [HR] = 1.110, p < 0.001), MHO had a higher risk (HR = 1.145, p = 0.002), and MUO further elevated this risk (HR = 1.238, p < 0.001). As for 90-day readmissions, both MUNO and MHO raised the risk slightly (HR = 1.134, p < 0.001; HR = 1.093, p = 0.014, respectively), and MUO had the highest risk (HR = 1.263, p < 0.001). Conclusions: Metabolic abnormalities were associated with elevated rates and risks of 30- or 90-day readmission among postmenopausal hospitalized women complicated with osteoporosis, whereas obesity did not seem to be innocent, and the combination of these factors led to an additional burden on healthcare systems and individuals. These findings indicate that clinicians and researchers should focus not only on weight management but also metabolism intervention among patients with postmenopausal osteoporosis.

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National Trends in Readmission and Resource Utilization After Pancreatectomy in the United States

Cited by 9 publications

References 25 publications

Factors Affecting the Readmission of Patients with Pancreatic Cancer after Surgery

Factors Affecting the Readmission of Patients with Pancreatic Cancer after Surgery

Surgical Decisions Based on a Balance between Malignancy Probability and Surgical Risk in Patients with Branch and Mixed-Type Intraductal Papillary Mucinous Neoplasm

Association between Metabolic Obesity Phenotypes and the Burden of Hospitalized Postmenopausal Patients Concomitant with Osteoporosis: A Retrospective Cohort Study Based on the National Readmission Database

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