title: Multivariable analysis of factors associated with hospital readmission following pancreaticoduodenectomy for malignant diseases.
abstract: BACKGROUND
  Readmission rates after pancreaticoduodenectomy (PD) for malignant diseases have a significant impact on survival rate. Identification of risk factors for readmission may improve discharge plans and postoperative care. Data exist on the morbidity and mortality of patients undergoing PD, but there are few reports about hospital readmissions after this procedure. Our aims were to evaluate the proportion and reasons for readmissions after PD for malignant diseases, the factors influencing readmissions, and to analyze the relationship between readmission rate and survival rate.
  
  
  METHODS
  Four hundred and thirty-six patients, who had undergone PD for malignant diseases in our centre from October 1999 to October 2009, a 10-year period, excluding perioperative (30-day) mortality, were identified. All readmissions within 1 year following PD were analyzed with respect to timing, location, reasons for readmission and outcome. We reviewed the hospitalization and readmissions for patients undergoing PD, and compared patients requiring readmission to patients that did not require readmission.
  
  
  RESULTS
  One hundred and forty-five patients (33.26%) were readmitted within 1 year following PD, for further treatment or complications. In those cases, diagnoses associated with high rates of readmission included radiation and/or chemotherapy (48.96%), progression of disease (11.72%), infection (11.72%), gastrointestinal dysfunction/obstruction (6.20%), surgery-related complications (2.76%) and pain (4.14%). The proportion of T4 in readmission group was lower than no readmission group (P < 0.05). The proportion of node positive cases in readmission group was much higher than no readmission group (P < 0.01). The number of readmission for complications reduced gradually in the first three months, and reached a second peak in the sixth and seventh month. Median survival was lower for the readmission group compared with the no readmission group (21 versus 46 months, P = 0.024).
  
  
  CONCLUSIONS
  These results may assist in both anticipating and facilitating postoperative care as well as managing patient expectations.
authors.affiliation: Institute of Micro-Invasive Surgery of Zhejiang University, Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China.
authors.forename: Zi-Yi
authors.initials: ZY
authors.lastname: Zhu
authors.forename: Ji-Kai
authors.initials: JK
authors.lastname: He
authors.forename: Yi-Fan
authors.initials: YF
authors.lastname: Wang
authors.forename: Xiao
authors.initials: X
authors.lastname: Liang
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.forename: Xian-Fa
authors.initials: XF
authors.lastname: Wang
authors.forename: Xiu-Jun
authors.initials: XJ
authors.lastname: Cai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications