Readmission after pancreatic resection: Causes and causality pattern Journal Article

Authors: Sadot, E.; Brennan, M. F.; Lee, S. Y.; Allen, P. J.; Gonen, M.; Groeger, J. S.; Kingham, T. P.; D'Angelica, M. I.; DeMatteo, R. P.; Jarnagin, W. R.; Fong, Y.
Article Title: Readmission after pancreatic resection: Causes and causality pattern
Abstract: Methods: Between 2011 and 2012, a total of 490 patients underwent pancreaticoduodenectomy, distal pancreatectomy or central pancreatectomy. Logistic regression was used to identify predictors of readmission. K-medoids clustering was performed to identify the major readmission subgroups. Results: Median postoperative length of stay (LOS) was 7 days, and the 30- and 90-day readmission rates were 23 and 29 %, respectively. The most common cause for 30-day readmissions was procedure-related infections (58 %), while the most common cause for 31–90-day readmissions was failure to thrive and chemotherapy-related symptoms (38 %). Independent predictors of 30-day readmissions were central pancreatectomy, discharge with a drain, pancreatic duct <3 mm, previous abdominal surgery, and postoperative LOS. Independent predictors for 31–90-day readmissions were age and preoperative serum carcinoembryonic antigen. Cancer-related covariates were more common in the 31–90-day readmission group. Postoperative carbohydrate antigen 19-9 levels were twofold higher in the 31–90-day readmission group compared with the no readmission group (p = 0.03). K-medoids clustering identified a subgroup where 74 % of readmissions occur at a median of 7 days after discharge. Conclusions: Readmissions after pancreatic operations are procedure-related in the first 30 days, but those after this period are influenced by the natural history of the underlying diagnosis. The readmission penalty policy should account for the timing of readmission and the natural history of the underlying disease and procedure. Early follow-up for patients at high risk for readmission may minimize early readmissions. Background: Readmission rates have been targeted for cost/reimbursement control. Our goal was to identify causes for readmission and delineate the pattern of early and late readmission.
Keywords: adult; controlled study; aged; cancer surgery; major clinical study; gastrointestinal hemorrhage; unspecified side effect; cancer adjuvant therapy; pancreas cancer; pancreas resection; antineoplastic agent; preoperative evaluation; prospective study; pancreaticoduodenectomy; protein blood level; abdominal abscess; ca 19-9 antigen; carcinoembryonic antigen; cystadenoma; intraductal papillary mucinous tumor; pancreas cyst; deep vein thrombosis; prediction; age; sarcoma; lung embolism; postoperative complication; length of stay; hospitalization; carcinoma in situ; pancreatitis; reoperation; surgical infection; pancreas adenocarcinoma; surgical mortality; hospital discharge; invasive carcinoma; hospital readmission; abdominal surgery; epidemiology; portal vein thrombosis; acinar cell carcinoma; distal pancreatectomy; pancreas disease; small intestine obstruction; pancreas islet cell tumor; anastomosis leakage; solid pseudopapillary tumor; mucinous cystic neoplasm; pancreas fistula; pancreas metastasis; acinar cell cystadenoma; paralytic ileus; failure to thrive; pancreas adenoma; central pancreatectomy; medical device complication; human; male; female; article; abdominal drain; drain malfunction; gastric dysmotility; pancreas leak; pancreas retention cyst; pancreas sarcoma; patient history of surgery
Journal Title: Annals of Surgical Oncology
Volume: 21
Issue: 13
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2014-12-01
Start Page: 4342
End Page: 4350
Language: English
DOI: 10.1245/s10434-014-3841-0
PROVIDER: scopus
PUBMED: 25047467
PMCID: PMC4529329
Notes: Export Date: 2 January 2015 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    782 Brennan
  2. Ronald P DeMatteo
    602 DeMatteo
  3. Mithat Gonen
    716 Gonen
  4. Peter Allen
    442 Allen
  5. William R Jarnagin
    596 Jarnagin
  6. Yuman Fong
    745 Fong
  7. T Peter Kingham
    293 Kingham
  8. Jeffrey Groeger
    52 Groeger
  9. Ser Yee Lee
    9 Lee
  10. Eran Sadot
    36 Sadot