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Impact of Post-Discharge Disposition on Risk and Causes of Readmission Following Liver and Pancreas Surgery

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

The relationship between the post-discharge settings and the risk of readmission has not been well examined. We sought to identify the association between discharge destinations and readmission rates after liver and pancreas surgery.

Methods

The 2013–2015 Medicare-Provider Analysis and Review (MEDPAR) database was reviewed to identify liver and pancreas surgical patients. Patients were subdivided into three groups based on discharge destination: home/self-care (HSC), home with home health assistance (HHA), and skilled nursing facility (SNF). The association between post-acute settings, readmission rates, and readmission causes was assessed.

Results

Among 15,141 liver or pancreas surgical patients, 60% (n = 9046) were HSC, 26.9% (n = 4071) were HHA, and 13.4% (n = 2024) were SNF. Older, female patients and patients with ≥ 2 comorbidities, ≥ 2 previous admissions, an emergent index admission, an index complication, and ≥ 5-day length of stay were more likely to be discharged to HHA or SNF compared to HSC (all P < 0.001). Compared to HSC, HHA and SNF patients had a 34 and a 67% higher likelihood of 30-day readmission, respectively. The HHA and SNF settings were also associated with a 33 and a 69% higher risk of 90-day readmission. There was no association between discharge destination and readmission causes.

Conclusion

Among liver and pancreas surgical patients, HHA and SNF patients had a higher risk of readmission within 30 and 90 days. There was no difference in readmission causes and discharge settings. The association between discharge setting and the higher risk of readmission should be further evaluated as the healthcare system seeks to reduce readmission rates after surgery.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Qinyu Chen, Katiuscha Merath, Griffin Olsen, Fabio Bagante, Jay J. Idrees, Ozgur Akgul, Jordan Cloyd, Carl Schmidt, Mary Dillhoff, Eliza W. Beal, Susan White & Timothy M. Pawlik

  2. Department of Surgery, University of Verona, Verona, Italy

    Fabio Bagante

  3. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Timothy M. Pawlik

Authors
  1. Qinyu Chen
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  2. Katiuscha Merath
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  3. Griffin Olsen
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  4. Fabio Bagante
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  5. Jay J. Idrees
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  6. Ozgur Akgul
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  7. Jordan Cloyd
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  8. Carl Schmidt
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  9. Mary Dillhoff
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  10. Eliza W. Beal
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  11. Susan White
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  12. Timothy M. Pawlik
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All authors have participated sufficiently in the work to take public responsibility for appropriate portions of the content.

Corresponding author

Correspondence to Timothy M. Pawlik.

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The authors declare that they have no conflict of interest.

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Chen, Q., Merath, K., Olsen, G. et al. Impact of Post-Discharge Disposition on Risk and Causes of Readmission Following Liver and Pancreas Surgery. J Gastrointest Surg 22, 1221–1229 (2018). https://doi.org/10.1007/s11605-018-3740-y

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  • DOI: https://doi.org/10.1007/s11605-018-3740-y

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