Abstract
Introduction
Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2 years) following Hepatopancreatobiliary (HPB) surgery in the state of New York.
Methods
The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2 years following surgery to identify all-cause readmissions. Factors for readmissions included patient demographics, comorbidities, perioperative complications, surgery type, and academic status. Multivariable generalized linear mixed models were performed to evaluate risk factors for readmissions.
Results
There were 6207 complex HPB procedures with 1272 (20.49%) unplanned 30-day readmissions, 816 (13.15%) unplanned 31–90-day readmissions, 1678 (27.03%) unplanned 91-day to 1-year readmissions, and 1404 (22.62%) 1–2-year readmissions. After adjusting for other possible confounding factors, risk factors for 30-day readmissions include surgery type, as pancreatectomy and gallbladder patients are more likely to have a 30-day readmission than hepatectomy patients, facility type, as academic centers are more likely to have a readmission, male gender, presence of any comorbidity, and peri-operative complications. Risk factors for 31–90-day readmissions include race, insurance group, any comorbidity or any peri-operative complication, and 30-day readmissions. Risk factors for 91-day to 1-year readmissions include male gender, race, any comorbidity, 30-day readmissions, and 31–90 days’ readmissions. Risk factors for 1–2-year readmissions include presence of any comorbidity, and previous 91-day to 1-year readmissions.
Conclusion
The 30-day readmission window is an inadequate, but predictive, measure of total readmission following complex HPB procedures.
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References
Verseman SR, Birkmeyer NJ (2014) Working together: regional collaboration and readmissions. Surg Obes Relat Dis 10(3):382–384
TheCenters for Medicare and Medicaid Services. Readmissions Reduction Program (2012) http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/, and AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed 19 Sept 19 2017
The Leapfrog Group. Potential benefits of national implementation of leapfrog hospital rewards program (2013). http:// www.leapfroggroup.org/media/file/What_are_the_benefits-rewards_program-2.26.08.pdf
Clarke A (1990) Are readmissions avoidable? BMJ, 301: 1136–1138
Joynt KE, Jha AK (2013) Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA 309(4):342–343
Joynt KE, Orav EJ, Jha AK (2011) Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA 305:675–681
Joynt KE, Jha AK (2011) Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives. Circ Cardiovasc Qual Outcomes 4:53–59
Telem DA, Talamini M, Gesten F, Patterson W, Peoples B, Gracia G, Yang J, Zhang Q, Altieri M, Pryor AD (2015) Hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter. Surg Endosc 29(6):1310–1315
Sano T, Shimada K, Sakamoto Y, Yamamoto J, Yamasaki S, Kosuge T (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244(2):240–247
Riall TS, Nealon WH, Goodwin JS, Zhang D, Kuo YF, Townsend CM Jr, Freeman JL (2006) Pancreatic cancer in the general population: improvements in survival over the last decade. J Gastrointest Surg 10(9):1212–1223
Kim JH, Li G, Baek NH, Hwang JC, Hong J, Yoo BM, Kim WH (2013) Surgical outcomes of distal pancreatectomy. Hepatogastroenterology 60(126):1263–1267
Reeh M, Nentwich MF, Bogoevski D, Koenig AM, Gebauer F, Tachezy M, Izbicki JR, Bockhorn M (2011) High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg 35(5):1110–1117
Reddy DM, Townsend CM Jr, Kuo YF, Freeman JL, Goodwin JS, Riall TS (2009) Readmission after pancreatectomy for pancreatic cancer in medicare patients. J Gastrointest Surg 13(11):1963–1974
Emick DM, Riall TS, Cameron JL et al (2006) Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 10(9):1243–1252
van Geenen RC, van Gulik TM, Busch OR, de Wit LT, Obertop H, Gouma DJ (2001) Readmissions after pancreatoduodenectomy. Br J Surg 88(11):1467–1471
Yermilov I, Bentrem D, Sekeris E et al (2009) Readmissions following pancreaticoduodenectomy for pancreas cancer: a population-based appraisal. Ann Surg Oncol 16(3):554–561
Brudvik KW, Mise Y, Conrad C, Zimmitti G, Aloia TA, Vauthey JN (2015) Definition of readmission in 3,041 patients undergoing hepatectomy. J Am Coll Surg 221(1):38–46
Fisher AV, Fernandes-Taylor S, Campbell-Flohr SA, Clarkson SJ, Winslow ER, Abbott DE, Weber SM (2017) 30-day readmission after pancreatic resection: a systematic review of the literature and meta-analysis. Ann Surg Oncol 266(2):242–250
Sadot E, Brennan MF, Lee SY et al (2014) Readmission after pancreatic resection: causes and causality pattern. Ann Surg Oncol 21(13):4342–4350
Lucas DJ, Sweeney JF, Pawlik TM (2014) The timing of complications impacts risk of readmission after hepatopancreatobiliary surgery. Surgery 155:945–953
Schneider EB, Hyder O, Wolfgang CL et al (2012) Patient readmission and mortality after surgery for hepato-pancreatobiliary malignancies. J Am Coll Surg 215:607–615
Spolverato G, Ejaz A, Kim Y et al (2014) Readmission incidence and associated factors after a hepatic resection at a major hepato-pancreaticobiliary academic centre. HPB (Oxford) 16:972–978
Acknowledgements
We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.
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No industry or other funding was used for this research.
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All authors contributed to this study and met all four criteria of as per the guidelines of the International Committee of Medical Journal Editors (ICMJE).
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Dr. Pryor is a speaker for Gore, Ethicon, Medtronic, Merck, and Stryker. She has received research support from Obalon and Baronova. There are no other conflicts of interest or financial disclosures for any of the authors.
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Altieri, M.S., Yang, J., Yin, D. et al. Thirty days are inadequate for assessing readmission following complex hepatopancreatobiliary procedures. Surg Endosc 33, 2508–2516 (2019). https://doi.org/10.1007/s00464-018-6539-8
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DOI: https://doi.org/10.1007/s00464-018-6539-8