The timing of complications impacts risk of readmission after hepatopancreatobiliary surgery

Background Readmission is frequent in hepatopancreatobiliary (HPB) surgery. Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. Study des...

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Veröffentlicht in:Surgery 2014-05, Vol.155 (5), p.945-953
Hauptverfasser: Lucas, Donald J., MD, MPH, Sweeney, John F., MD, Pawlik, Timothy M., MD, MPH, PhD
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container_end_page 953
container_issue 5
container_start_page 945
container_title Surgery
container_volume 155
creator Lucas, Donald J., MD, MPH
Sweeney, John F., MD
Pawlik, Timothy M., MD, MPH, PhD
description Background Readmission is frequent in hepatopancreatobiliary (HPB) surgery. Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. Study design Elective HPB resections were selected from the 2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Risk factors associated with readmission were assessed using modified Poisson univariate and adjusted regression models. Results We identified 5,081 patients; 2,980 underwent pancreatic resection and 2,101 had a hepatectomy. Median age was 62 (interquartile range, 52–70), 53% of patients were women; 74% were non-Hispanic white; and 31% were American Society of Anesthesiologists (ASA) class 2, and 64% were ASA class 3. About 75% of cases had a malignant diagnosis on final pathology. Of all these patients, 16.2% were readmitted within 30 days of operation. The strongest risk factors for readmission on multivariable analysis were minor (risk ratio [RR], 3.13, 95% confidence interval [CI], 2.47–3.97; P < .001) and major (RR, 8.45; 95% CI, 7.59–9.40; P < .001) complications after discharge; in contrast, major inpatient complications only had a modest effect on the risk of readmission (RR, 1.29; 95% CI, 1.05–1.58; P < .014). Among all patients who were readmitted, 40% experienced a major complication after discharge, and 83% of patients who had a major outpatient complication were readmitted. Conclusion Outpatient complications were by far the strongest risk factor for readmission. Decreasing complications as well as improving outpatient case management to prevent and treat postdischarge complications hold considerable promise in the efforts to decrease readmission.
doi_str_mv 10.1016/j.surg.2013.12.034
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Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. Study design Elective HPB resections were selected from the 2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Risk factors associated with readmission were assessed using modified Poisson univariate and adjusted regression models. Results We identified 5,081 patients; 2,980 underwent pancreatic resection and 2,101 had a hepatectomy. Median age was 62 (interquartile range, 52–70), 53% of patients were women; 74% were non-Hispanic white; and 31% were American Society of Anesthesiologists (ASA) class 2, and 64% were ASA class 3. About 75% of cases had a malignant diagnosis on final pathology. Of all these patients, 16.2% were readmitted within 30 days of operation. The strongest risk factors for readmission on multivariable analysis were minor (risk ratio [RR], 3.13, 95% confidence interval [CI], 2.47–3.97; P &lt; .001) and major (RR, 8.45; 95% CI, 7.59–9.40; P &lt; .001) complications after discharge; in contrast, major inpatient complications only had a modest effect on the risk of readmission (RR, 1.29; 95% CI, 1.05–1.58; P &lt; .014). Among all patients who were readmitted, 40% experienced a major complication after discharge, and 83% of patients who had a major outpatient complication were readmitted. Conclusion Outpatient complications were by far the strongest risk factor for readmission. 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Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. Study design Elective HPB resections were selected from the 2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Risk factors associated with readmission were assessed using modified Poisson univariate and adjusted regression models. Results We identified 5,081 patients; 2,980 underwent pancreatic resection and 2,101 had a hepatectomy. Median age was 62 (interquartile range, 52–70), 53% of patients were women; 74% were non-Hispanic white; and 31% were American Society of Anesthesiologists (ASA) class 2, and 64% were ASA class 3. About 75% of cases had a malignant diagnosis on final pathology. Of all these patients, 16.2% were readmitted within 30 days of operation. The strongest risk factors for readmission on multivariable analysis were minor (risk ratio [RR], 3.13, 95% confidence interval [CI], 2.47–3.97; P &lt; .001) and major (RR, 8.45; 95% CI, 7.59–9.40; P &lt; .001) complications after discharge; in contrast, major inpatient complications only had a modest effect on the risk of readmission (RR, 1.29; 95% CI, 1.05–1.58; P &lt; .014). Among all patients who were readmitted, 40% experienced a major complication after discharge, and 83% of patients who had a major outpatient complication were readmitted. Conclusion Outpatient complications were by far the strongest risk factor for readmission. 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Medicare began penalizing hospitals recently for excess readmission for specific diagnoses, including some operative procedures. We sought to define the incidence and risk factors for readmission after HPB surgery. Study design Elective HPB resections were selected from the 2011 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset. Risk factors associated with readmission were assessed using modified Poisson univariate and adjusted regression models. Results We identified 5,081 patients; 2,980 underwent pancreatic resection and 2,101 had a hepatectomy. Median age was 62 (interquartile range, 52–70), 53% of patients were women; 74% were non-Hispanic white; and 31% were American Society of Anesthesiologists (ASA) class 2, and 64% were ASA class 3. About 75% of cases had a malignant diagnosis on final pathology. Of all these patients, 16.2% were readmitted within 30 days of operation. 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subjects Adult
Aged
Aged, 80 and over
Biliary Tract Surgical Procedures
Female
Hepatectomy
Humans
Incidence
Male
Middle Aged
Outpatients
Pancreatectomy
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology
Regression Analysis
Retrospective Studies
Risk Factors
Surgery
Time Factors
title The timing of complications impacts risk of readmission after hepatopancreatobiliary surgery
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