A. C. Beck1, P. Goffredo1, X. Gao1, P. W. McGonagill1, R. J. Weigel1, I. Hassan1 1University Of Iowa,Department Of Surgery,Iowa City, IA, USA
Introduction: Readmissions are a burden to the healthcare system and used as a quality metric. Over 400,000 outpatient laparoscopic cholecystectomies (LC) are performed annually in the United States and decreasing readmissions could represent a significant opportunity for quality improvement. The aim of this study is to determine causes of readmissions and identify modifiable risk factors.
Methods: Patients (pts) undergoing only elective outpatient LCs were identified from the 2013-2015 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database by Current Procedural Terminology (CPT) codes 47562 (LC) and 47563 (LC+intraoperative cholangiogram/IOC). ICD-9 and 10 codes were used to identify reasons for LC and readmissions. Student-t, chi-square and Mann-Whitney tests were used to assess continuous and categorical variables.
Results: A total of 69,376 pts underwent LC or LC+IOC, of which 2027 (2.9%) were readmitted within 30 days. The majority (71.5%) of readmissions were related to surgery and occurred after a median of 5 days (interquartile range 3-8). The cohort had a mean age of 48 years±16, females 75%, BMI 31±8, ASA ≥3 27%, IOC 22% and mean operative time 58±34 minutes. Indications for LC were cholecystitis (72%), gallstones without (wo) obstruction (22%), pancreatitis (1%), and gallstones with (w) obstruction (0.3%). Readmission rates varied by indication: pancreatitis (4.9%), gallstones w obstruction (3.9%), cholecystitis (3.0%) and gallstones wo obstruction (2.6%) (p=0.003). The most frequent causes for readmissions were infection, retained stones, and other GI complications (Table). In adjusted analyses, readmitted pts were older, males, had higher ASA, longer operative times, and higher rates of post-operative complications (all p<0.001), however these factors varied by the reasons for readmission. Pts readmitted for infection or cardiopulmonary complications were older with higher ASA (p<0.01), while pts with pain, retained stones and other GI complications were younger with lower ASA (p<0.01). Pts who underwent LC+IOC had a lower readmission rate due to retained stones compared to LC alone (0.17% vs 0.31%, p=0.006). Abnormal serum bilirubin and indication for LC did not correlate with readmission for retained stones (p=0.21 and p=0.33).
Conclusions: Readmissions following outpatient LC are infrequent and depend on the preoperative indications. They occur for diverse reasons usually within the first week. Associated factors are patient and disease related, and are not all preventable or modifiable. In selected patients increased IOC use may decrease readmissions from retained stones.
