Fast-Track Pancreaticoduodenectomy: Factors Associated with Early Discharge
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Pancreaticoduodenectomy is a complex surgery frequently associated with prolonged hospitalizations. However, there are a subset of patients discharged within 5 days from surgery; the preoperative and intraoperative characteristics of this subset are unknown.
The NSQIP Targeted Pancreatectomy Dataset was used from 2014 to 2016. Patients who died within 30 days were excluded. A total of 10,741 patients undergoing pancreaticoduodenectomy were identified. Univariable and multivariable logistic regression analyses were performed for preoperative and intraoperative ACS-NSQIP variables to identify predictors of early discharge. Early discharge was defined as discharge 3–5 days after surgery.
A total of 1105 patients (10.3%) were discharged within 5 days following pancreaticoduodenectomy. On multivariable analysis, preoperative factors associated with early discharge included younger age (OR 0.988, p < 0.001), non-obesity (OR 0.737, p = 0.001), those receiving neoadjuvant chemotherapy (OR 1.424, p < 0.001), and lack of COPD (OR 0.489, p = 0.005) or hypertension (OR 0.805, p = 0.007). Intraoperative factors associated with early discharge on multivariable analysis were shorter operation duration (OR 0.999, p = 0.002), minimally invasive surgery (OR 3.537, p < 0.001), and hard pancreatic texture (OR 1.480, p < 0.001). Intraoperative factors associated with non-early discharge were epidural placement (OR 0.485, p < 0.001), drain placement (OR 0.308, p < 0.001), and jejunostomy tube placement (OR 0.278, p < 0.001). Patients discharged within 5 days had a 14.7% readmission rate compared to 17.0% for later discharges (p = 0.047).
Multiple preoperative and intraoperative factors, including some that are potentially modifiable, were significantly associated with early discharge after pancreaticoduodenectomy. Patients with these characteristics may benefit from enhanced recovery after surgery programs and expedited disposition planning postoperatively.
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Conflict of interest
The authors declare that they have no conflict of interest.
- 7.Sharpe SM, Talamonti MS, Wang CE et al (2015) Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the national cancer data base. J Am Coll Surg 221(1):175–184CrossRefGoogle Scholar
- 8.Baker EH, Ross SW, Seshadri R et al (2015) Robotic pancreaticoduodenectomy for pancreatic adenocarcinoma: role in 2014 and beyond. J Gastrointest Oncol 6(4):396–405Google Scholar
- 16.American College of Surgeons (2018) ACS national surgical quality improvement program. https://www.facs.org/quality-programs/acs-nsqip. Accessed 19 Apr 2018
- 19.Nimmo SM, Harrington LS (2014) What is the role of epidural analgesia in abdominal surgery? Br J Anaesth 14(5):224–229Google Scholar
- 27.Porter ME, Kaplan RS (2016) How to pay for health care. Harv Bus Rev 94(7–8):88–98Google Scholar
- 28.Kaplan RS, Porter ME (2011) How to solve the cost crisis in health care. Harv Bus Rev 89(9):46–52Google Scholar