Abstract
Introduction
Unplanned readmission is a common event after liver resection, and it is a burden for both patients and healthcare policy makers. This study evaluates the incidence of and reasons for unplanned readmission after liver resection, in order to identify possible preventable causes.
Methods
In this single-center cohort study, data from patients who underwent liver resection for both malignant and benign indications from 2001 to 2016 at our institute were collected from a database with prospective data. Readmissions were analyzed for their reasons and risk factors. Patients with general complaints with no specific complications were categorized as failure to thrive.
Results
In 406 patients, the readmission rate was 11.6%. Most patients were readmitted because of failure to thrive (35%), deep and superficial surgical site infection (28%), or cardiopulmonary complications (15%). A multivariate analysis revealed that unplanned readmission was associated with the occurrence of complications during index admission—with an odds ratio of 4.69 (CI 2.41–9.12, p < 0.001).
Conclusion
Readmission occurs in more than 1 in 10 patients after liver resection, and it is associated with a complicated course during index admission. One-third of readmissions occur because of failure to thrive and might be preventable. Future research in strategies to reduce readmission rates should focus on both the prevention of complications during index admission and programs at the interface between primary and secondary care.
Similar content being viewed by others
References
Barbas AS, Turley RS, Mallipeddi MK, Lidsky ME, Reddy SK, White RR, Clary BM (2013) Examining reoperation and readmission after hepatic surgery. J Am Coll Surg 216(5):915–923
Spolverato G, Ejaz A, Kim Y, Weiss M, Wolfgang CL, Hirose K, Pawlik TM (2014) Readmission incidence and associated factors after a hepatic resection at a major hepato-pancreatico-biliary academic centre. HPB 16(11):972–978
Kimbrough CW, Agle SC, Scoggins CR, Martin RC, Marvin MR, Davis EG, McMasters KM, Jones CM (2014) Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. Surgery 156(4):1039–1046
Tamandl D, Butte JM, Allen PJ, D’Angelica MI, DeMatteo RP, Groeger JS, Jarnagin WR, Fong Y (2015) Hospital readmissions after liver surgery for metastatic colorectal cancer. Surgery 157(2):231–238
Narula N, Kim BJ, Davis CH, Dewhurst WL, Samp LA, Aloia TA (2018) A proactive outreach intervention that decreases readmission after hepatectomy. Surgery 163(4):703–708
Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Christensen BM, Kehlet H, Hillingso JG (2013) Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg 100(1):138–143
Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Kehlet H, Hillingso JG (2018) Second generation of a fast-track liver resection programme. World J Surg 42(6):1860–1866. https://doi.org/10.1007/s00268-017-4399-3
Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK (2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369(12):1134–1142
Hughes MJ, McNally S, Wigmore SJ (2014) Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB 16(8):699–706
van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH (2008) Enhanced recovery after surgery (ERAS) group. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg 95(8):969–975
Spelt L, Ansari D, Sturesson C, Tingstedt B, Andersson R (2011) Fast-track programmes for hepatopancreatic resections: where do we stand? HPB 13(12):833–838
He F, Lin X, Xie F, Huang Y, Yuan R (2015) The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol 17(9):694–701
Connor S, Cross A, Sakowska M, Linscott D, Woods J (2013) Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB 15(4):294–301
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Spolverato G, Maqsood H, Vitale A, Alexandrescu S, Marques HP, Aldrighetti L, Gamblin TC, Pulitano C, Bauer TW, Shen F, Poultsides G, Maithel S, Marsh JW, Pawlik TM (2015) Readmission after liver resection for Intrahepatic cholangiocarcinoma: a multi-institutional analysis. J Gastrointest Surg 19(7):1334–1341
Kim S, Maynard EC, Shah MB, Daily MF, Tzeng CW, Davenport DL, Gedaly R (2015) Risk factors for 30-day readmissions after hepatectomy: analysis of 2444 patients from the ACS-NSQIP database. J Gastrointest Surg 19(2):266–271
Egger ME, Squires MH 3rd, Kooby DA, Maithel SK, Cho CS, Weber SM, Winslow ER, Martin RC 2nd, McMasters KM, Scoggins CR (2015) Risk stratification for readmission after major hepatectomy: development of a readmission risk score. J Am Coll Surg 220(4):640–648
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
de Klein, G.W., Brohet, R.M., Liem, M.S.L. et al. Possible Preventable Causes of Unplanned Readmission After Elective Liver Resection, Results from a Non-academic Referral HPB Center. World J Surg 43, 1802–1808 (2019). https://doi.org/10.1007/s00268-019-04970-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-019-04970-8