I. Folkert1, S. Damrauer1, G. Karakousis1, M. K. Lee, IV1 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA
Introduction: Readmission rates have been highlighted as a target for cost-control in healthcare. Pancreatectomy is associated with high readmission rates, and multiple studies have identified factors associated with 30-day readmission. This study sought to delineate differences in patients readmitted early after discharge versus those readmitted remotely.
Methods: Patients who underwent open pancreatectomy were identified in the 2008-2010 California State Inpatient Database. Patients were stratified according to whether they were first readmitted at days 0-30 post-discharge (early), 31-90 (intermediate), 91-365 (late), or had no readmissions within the first year. Descriptive statistics were used to characterize each readmission group. Multinominal logistic regression was used to identify risk factors for readmission by timeframe.
Results: 3,118 patients underwent pancreatectomy. 1,507 (48%) patients were readmitted in the year following discharge (21.6% early, 8.9% intermediate, 17.9% late). The median time to first readmission was 43 days (IQR 9 – 165). The median number of readmissions within the first year for readmitted patients was 2 (IQR 1-3).
Demographically, age (p < 0.0001), insurance status (p = 0.0001), diagnosis (p < 0.0001), and malignancy (p < 0.0001) were the most significant predictors of readmission. A similar percentage of patients with malignant and benign disease were first readmitted within 30 days (21.5% and 22.0%, respectively). However, 20.7% of patients with malignancy versus only 8.8% of patients with benign disease were first readmitted at day 91-365. Comorbidities that had the most significant associations with readmissions were hypertension, CHF, metastatic disease (including lymph nodes), renal failure, and weight loss (p < 0.0001 for all). The complication that was most strongly associated with readmission was postoperative shock (OR 26.7 [95% CI 5.2 – 489] early, OR 11.8 [95% CI 1.1 – 253] intermediate, OR 11.6 [95% CI 1.7 – 228] late). Factors not significantly associated with readmission included obesity (p = 0.496), race (p = 0.055), income (p = 0.549), wound complications (p = 0.244), and GI complications (p = 0.524).
Complications related to surgical/medical care were the primary reason for 39.9% of early readmissions but only 15.9% of intermediate and 6.1% of late readmissions. However, the primary procedure performed on readmission was similar in all groups. Either an abdominal drainage procedure or an upper endoscopy was the primary procedure in 22.3% of early readmissions, 17.9% of intermediate readmissions, and 14.2% of late readmissions.
Conclusions: Reducing readmissions after pancreatectomy remains challenging. Time to first readmission after pancreatectomy can vary widely, and 30-day readmission rates can therefore underestimate the extent of the problem. Reasons for readmission vary with time, but invasive interventions are often necessary at any time point.