Tracking Early Readmission After Pancreatectomy to Index and Nonindex Institutions

Abstract

Importance Readmission after pancreatectomy is common, but there is a paucity of data comparing patterns of readmission to index and non-index hospitals. Objective To evaluate the rate of readmission to index and non-index institutions following pancreatectomy at a tertiary high-volume institution, and to identify patient-level factors predictive of those readmissions Design, Setting, Participants Retrospective analysis of a prospectively-collected institutional database linked to statewide data of patients who underwent pancreatectomy at a tertiary care referral center (01/2005-12/2-2010). Exposure Pancreatectomy Main Outcome Measure The primary outcome was unplanned 30-day readmission to the index or non-index hospitals. Risk factors and reasons for readmission were measured and compared by site using univariable and multivariable analyses. Results Among all 623 patients who underwent pancreatectomy during the study period, 134 (21.5%) were readmitted to either our institution (n=105, 78.4%) or an outside institution (n=29, 21.6%). Fifty-six patients (41.8%) were readmitted due to gastrointestinal or nutritional problems related to surgery and 42 (31.3%) due to a postoperative infection. On multivariable analysis, factors independently associated with readmission included age ≥65 (OR 1.80, 95% CI 1.19-2.71), pre-existing liver disease (OR 2.28, 95% CI 1.23-4.24), distal pancreatectomy (OR 1.77, 95% CI 1.11-2.84), and postoperative drain placement (OR 2.81, 95% CI 1.10-7.14). Conclusions and Relevance In total, 21.5% of patients required early readmission after pancreatectomy. Even in the setting of a tertiary care referral center, nearly 22% of these readmissions were to non-index institutions. Specific patient-level factors were associated with increased risk of readmission.

Fragmentation of Care after Surgical Discharge: Non-Index Readmission after Major Cancer Surgery

“…18 Despite the ponderous evidence from medical research that associates provider continuity with better patient outcomes and provider fragmentation with lower quality of care and higher costs, 19–22 this hypothesis has not been sufficiently tested in postoperative settings. In the case of major cancer surgery, readmissions are known to be strongly driven by surgical complications, 2,4–6,10,17,23,24 making provider and information continuity particularly relevant in such scenarios. However, the relationship between location and outcomes of readmission remains largely unexplored among cancer patients, with the exception of gastrectomy and radical cystectomy.…”

Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy

“…Patients who died during their initial hospitalization or within 30 days of surgery (ie, perioperative deaths; n = 13) and those who underwent planned readmission (ie, to rehabilitation institutions; n = 15) were excluded from subsequent analysis 5,9,10 to allow specifically for the study of long-term outcomes. Given the low incidence of minimally invasive pancreatectomy at our institution during the study period, we also excluded subjects who underwent laparoscopic and/or robotic surgery to reduce the potential for confounding.…”

“…Additional details regarding the data and methodology used herein have been published previously. 5 This study was approved by the Institutional Review Board at the Johns Hopkins Medical Institutions.…”

“…1,5–8 While previous studies have sought to identify factors associated with readmission after pancreatectomy, the impact of readmission on subsequent patient outcomes remains poorly understood. Specifically, there are limited data exploring the potential role of early readmission as an independent marker of long-term survival.…”

A Novel Risk Scoring System Reliably Predicts Readmission after Pancreatectomy

“…This study demonstrated that 21.6% of readmissions occurred at regional hospitals and, when accounted for, the observed frequency of readmission increased from 16.9% to 21.5%. 38 Therefore, it is uncertain if all readmissions are captured in this study.…”