A. Z. Paredes1, R. Mehta1, E. W. Beal1, F. Bagante2, A. Diaz1, K. Merath1, M. E. Dillhoff1, J. M. Cloyd1, T. M. Pawlik1 1Ohio State University,Department Of Surgery, Division Of Surgical Oncology,Columbus, OH, USA 2University of Verona,Surgery,Verona, Italy
Introduction: Hepatopancreatobiliary (HPB) surgeries are complex procedures that may require discharge to a facility other than home. As surgical patients age, the number of patients requiring post-discharge care may increase. We sought to identify factors associated with discharge disposition, as well as assess readmission risk relative to discharge services.
Methods: The National Readmissions Database (NRD) was used to identify patients who underwent HPB surgery between 2010-2015. Patients were stratified based on discharge destination: home, SNF/intermediate care, home with home health care (HHC). Factors associated with discharge disposition were assessed and 30-day and 90-day readmission were compared.
Results: Among 47,955 patients who underwent HPB surgery, mean age was 58 years (IQR, 50-69), 53.4% were female and 48.9% had >3 comorbidities. Surgery consisted of hepatectomy (N=26,135, 54.5%), pancreatectomy (N=13,180, 27.5%) or biliary procedure (N=8,640, 18.0%). At the time of discharge, the majority of patients were discharged to home (N=34,046, 71.0%), while a smaller proportion were discharged to SNF/intermediate care (N=3,385, 7.1%) or HHC (N=10,524, 21.9%). On multivariable analysis, older age (OR 1.07, 95%CI 1.07-1.08), >3 comorbidities (OR 2.09, 95%CI 1.46-2.99), and a high preoperative mortality risk score (OR 3.28, 95%CI 2.32-4.62) were associated with an increased risk of discharge to SNF/intermediate care (all p<0.05). Similarly, a high preoperative mortality risk score (OR 1.43, 95%CI 1.23-1.67), and loss of function (OR 3.21, 95%CI 2.48-4.16) were associated with discharge to HHC. While 13.7% and 15.8% of patients were readmitted following discharge to home or HCC, respectively, the incidence of 30-day readmission was 23.5% following discharge to SNF/intermediate care (p<0.001). In contrast, by 90 days the incidence of readmission was similar among patients discharged to SNF/intermediate care (34.2%) or HHC (30.5%), yet lower for patients who had been discharged home (19.1%) (p<0.001). Of note, patients discharged to SNF/intermediate care (23.1%) were at a higher odds of being readmitted to a non-index hospital (home, 13.7%, HHC, 15.8%)(p<0.001).
Conclusion: Following HPB surgery, 1 in 3 patients were either discharged with HHC or to SNF/intermediate care. Discharge with HHC or to SNF/intermediate care was associated with increased risk of both 30- and 90-day readmission, as well as readmission to a non-index hospital.