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Investigating Transitional Care to Decrease Post-pancreatectomy 30-Day Hospital Readmissions for Dehydration or Failure to Thrive

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Current literature emphasizes post-operative complications as a leading cause of post-pancreatectomy readmissions. Transitional care factors associated with potentially preventable conditions such as dehydration and failure to thrive (FTT) may play a significant role in readmission after pancreatectomy and have not been studied.

Methods

Thirty-one post-pancreatectomy patients, who were readmitted for dehydration or FTT between 2009 and 2014, were compared to 141 nonreadmitted patients. Medical record review and a questionnaire-based survey, specifically designed to assess transitional care, were used to identify predictors of readmissions for dehydration or FTT. Logistic regression models were used to evaluate outcomes.

Results

On multivariable analysis, the strongest predictors of readmission for dehydration and FTT were the patient’s lower educational level (P = 0.0233), the absence of family during the delivery of discharge instructions (P = 0.0098), episodic intermittent nausea at discharge (P = 0.0019), uncertainty about quantity, quality, or frequency of fluid intake (P = 0.0137), and the inability or failure to adhere to the clinician’s instructions in the outpatient setting (P = 0.0048).

Conclusion

Transitional-care-related factors are found to be associated with post-pancreatectomy readmission for dehydration and FTT. Using these results to identify high-risk patients and implement focused preventive measures combining efficient communication and optimal inpatient and outpatient management could potentially decrease readmission rates.

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Acknowledgments

We thank our colleagues at the division of Biostatistics at Harvard T.H. Chan School of Public Health who provided insight and expertise that greatly assisted our survey research methods. We also express our gratitude and appreciation to interviewees for sharing their experiences.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Dimitrios Xourafas, Thomas E. Clancy, Richard S. Swanson & Stanley W. Ashley

  2. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Dimitrios Xourafas & Akweley Ablorh

Authors
  1. Dimitrios Xourafas
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  2. Akweley Ablorh
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  3. Thomas E. Clancy
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Corresponding author

Correspondence to Dimitrios Xourafas.

Ethics declarations

The Institutional Review Board (IRB) approved all methods of data collection including the questionnaire and patient interviews.

Conflict of interest

We agree to the inclusion of our names in the list of authors on the manuscript in the order shown on the title page. D. Xourafas, A. Ablorh, T. E. Clancy, R. S. Swanson, and S. W. Ashley have no conflicts of interest or financial ties to disclose.

Appendix: Questionnaire

Appendix: Questionnaire

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Xourafas, D., Ablorh, A., Clancy, T.E. et al. Investigating Transitional Care to Decrease Post-pancreatectomy 30-Day Hospital Readmissions for Dehydration or Failure to Thrive. J Gastrointest Surg 20, 1194–1212 (2016). https://doi.org/10.1007/s11605-016-3121-3

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  • DOI: https://doi.org/10.1007/s11605-016-3121-3

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