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Readmission After Pancreaticoduodenectomy: The Influence of the Volume Effect Beyond Mortality.

Abstract：

BACKGROUND:As increased focus is placed on quality of care in surgery, readmission is an increasingly important metric by which hospital and surgeon quality is measured. For complex pancreatic surgery, we hypothesized that increased pancreaticoduodenectomy (PD) volume may mitigate readmission rates. METHODS:The University Healthsystems Consortium database was queried for all patients (n = 9805) undergoing PD from 2009 to 2011. Hospitals were stratified into quintiles based on number of cases performed annually. Univariate and multivariate logistic regression analyses were performed to identify factors associated with 30-day readmission. RESULTS:The 30-day readmission rate for patients undergoing PD was 19.1 %. Stratified by volume, hospitals performing the highest two quintiles of PDs annually (≥56 cases) had a significantly lower unadjusted readmission rate than those hospitals performing the lowest quintile (n ≤ 23 cases; 16.7 and 18.0 % vs. 20.9 %, p < 0.05). On univariate analysis, readmitted patients tended to have higher severity of illness (p < 0.01) and longer index admission (10 vs. 9 days, p < 0.01). Age and insurance status had no significant association with readmission. Multivariate analysis demonstrated that higher severity of illness (odds ratio [OR] 1.36, 95 % confidence interval [CI] 1.04-1.77, p = 0.02), discharge to rehab (OR 1.41, 95 % CI 1.19-1.66, p < 0.001), and surgery at the lowest volume hospitals (OR 1.28, 95 % CI 1.08-1.51, p = 0.004) were factors independently associated with readmission. CONCLUSIONS:Lower hospital volume is a significant risk factor for readmission after PD. To minimize the excess resource utilization that accompanies readmission, patients undergoing complex oncologic pancreatic surgery should be directed to hospitals most experienced in caring for this patient population.

journal_name

Ann Surg Oncol

journal_title

Annals of surgical oncology

authors

Sutton JM,Wilson GC,Wima K,Hoehn RS,Cutler Quillin R 3rd,Hanseman DJ,Paquette IM,Sussman JJ,Ahmad SA,Shah SA,Abbott DE

doi

10.1245/s10434-015-4451-1

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

3785-92

issue

eissn

1068-9265

issn

1534-4681

pii

10.1245/s10434-015-4451-1

journal_volume

pub_type

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Readmission After Pancreaticoduodenectomy: The Influence of the Volume Effect Beyond Mortality.