Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

Abstract

Background:In patients undergoing pancreatoduodenectomy, non-home discharge is common and often results in an unnecessary delay in hospital discharge. This study aimed to develop and validate a preoperative prediction model to identify patients with a high likelihood of non-home discharge following pancreatoduodenectomy. Methods:Patients undergoing pancreatoduodenectomy from 2013-2018 were identified using an institutional database. Patients were categorized according to discharge location (Home vs. Non-Home). Preoperative risk factors, including social determinants of health associated with nonhome discharge, were identified using Pearson's chi-squared test and then included in a multiple logistic regression model. A training cohort composed of 80% of the sampled patients was used to create the prediction model, and validation carried out using the remaining 20%. Statistical significance was defined as P < 0.05. Results:766 pancreatoduodenectomy patients met the study criteria for inclusion in the analysis (nonhome: 126; home: 640). Independent predictors of non-home discharge on multivariable analysis were age, marital status, mental health diagnosis, functional health status, dyspnea, and chronic obstructive pulmonary disease. The prediction model was then used to generate a nomogram to predict likelihood of non-home discharge. The training and validation cohorts demonstrated comparable performances with an identical area under the curve (0.81) and an accuracy of 84%. Conclusion:A prediction model to reliably assess the likelihood of non-home discharge after pancreatoduodenectomy was developed and validated in the present study.

Geographic Proximity of Family Members and Healthcare Utilization After Complex Surgical Procedures

“…36 Living alone is associated with prolonged hospitalization after cardiac surgery 32,37 and knee/hip arthroplasty. 38 With regards to the discharge destination, married individuals are more likely to be discharged home after pancreaticoduodenectomy, 39 orthopedic trauma, 40 and lower extremity amputation. 41 Our results are congruent with these findings.…”