title: Readmissions after pancreaticoduodenectomy: efforts need to focus on patient expectations and nonhospital medical care.
abstract: Readmissions after operations are a burden. This study was undertaken to determine factors predicting readmissions after pancreaticoduodenectomy. Since 1991, patients undergoing pancreaticoduodenectomy have been prospectively followed. Nineteen per cent of 913 patients were readmitted  within 30 days after discharge from pancreaticoduodenectomy. The causes for readmissions were reviewed. Median data are presented. All patients had preoperative comorbidities; most common were cardiovascular (26%), gastrointestinal (23%), or endocrine (15%). Twenty-nine per cent had extended  pancreaticoduodenectomy, including major vascular resections. The most common reasons for readmission were: nausea/vomiting (26%), wound infection (15%), and abdominal pain (18%). Gender, body mass index, duration of operation, blood loss, length of stay, pathology, American Joint Committee  on Cancer™ stage, and margin status did not predict readmission. Patients being readmitted were younger (65 vs 69 years, P < 0.001) and had more comorbidities (P < 0.001). Readmission did not curtail long-term survival. Pancreaticoduodenectomy is a complex  operation undertaken in patients with notable comorbidities. Readmissions occur frequently after pancreaticoduodenectomy and patients with more comorbidities are at particular risk. Readmissions are not generally the result of complications specific to pancreaticoduodenectomy, but seem more  related to ill health, inaccessible nonhospital medical care, and poor expectations. Efforts must focus on patient expectations, intermediate care, home health care, and improving medical care after discharge.
authors.affiliation: Tampa General Medical Group, Tampa General Hospital, Tampa, Florida, USA. arosemurgy@tgh.com
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Harold
authors.initials: H
authors.lastname: Paul
authors.forename: Franka
authors.initials: F
authors.lastname: Co
authors.forename: Michelle
authors.initials: M
authors.lastname: Vice
authors.forename: Paul
authors.initials: P
authors.lastname: Toomey
authors.forename: Edward
authors.initials: E
authors.lastname: Choung
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate