title: Readmission after major pancreatic resection: a necessary evil?
abstract: BACKGROUND
  Hospital readmission is under increased scrutiny as a quality metric for surgical performance, yet its relevance after elective, high-acuity operations is poorly understood. We sought to define the clinical nature and economic impact of readmission after major pancreatic resection.
  
  
  METHODS
  From 2001 to 2009, 578 pancreatic resections followed standardized perioperative care. Clinical and economic outcomes were evaluated and predictors of readmission were identified by regression analysis.
  
  
  RESULTS
  One hundred and eleven (19%) patients required readmission within 30 days (median 8 days post discharge), with only 12 more readmitted between 31 and 90 days. Twenty-three (21%) patients were readmitted multiple times. Reasons for readmission were procedure-specific complications (48%), general postoperative complications/infections (18.0%), failure to thrive (12%), or medical problems (9%). An additional 14% were readmitted solely for diagnostic evaluation of symptoms without cause. Neither preoperative demographics/acuity nor intraoperative factors influenced readmission. Instead, readmission was predicted by any (odds ratio = 2.24) or major (odds ratio = 2.19) complications, and clinically relevant (odds ratio = 5.05) or latent (odds ratio = 4.04) pancreatic fistula. Patient survival was negatively, but not significantly, associated with readmissions. Overall hospital stay and costs were markedly affected by readmission, as readmitted patients cost an average of $16,000 more.
  
  
  CONCLUSIONS
  In this practice-based analysis, readmissions after pancreatic resection were frequent, early, costly, and largely related to procedure-specific complications. As initial hospital stay continues to decline in high-acuity surgery, readmissions might be required for optimal management of complications, which often manifest later in the recovery course. Clinical pathway deviations predict potential readmissions, and might prompt adjustments in management and disposition of patients at risk for returning to the hospital.
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. tkent@bidmc.harvard.edu
authors.forename: Tara S
authors.initials: TS
authors.lastname: Kent
authors.forename: Teviah E
authors.initials: TE
authors.lastname: Sachs
authors.forename: Mark P
authors.initials: MP
authors.lastname: Callery
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000191:economics / Q000401:mortality; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome