title: Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients.
abstract: OBJECTIVE
  Morbidity, mortality, and length of hospital stay after pancreaticoduodenectomy (PD) have significantly decreased over recent decades. Despite this progress, early readmission rates after PD have been reported as high as 50%. Few reports have delineated factors associated with readmission after PD.
  
  
  METHODS
  The medical records of 6 high-volume institutions were reviewed for patients who underwent PD between 2005 and 2010. Data collection included patient characteristics, medical comorbidities, and perioperative factors. Analysis included readmissions up to 90 days after PD.
  
  
  RESULTS
  A total of 1302 patients underwent PD across all institutions. The 30-day and 90-day readmission rates were 15% and 19%, respectively. The most common reasons for 30-day readmission included infectious complications (n = 65) and delayed gastric emptying (n = 29). The most common reasons for readmission after 90 days included wound infections and intra-abdominal abscess (n = 75) and failure to thrive (n = 38). On multivariate analysis, factors associated with higher readmission rates included a preoperative diagnosis of chronic pancreatitis, higher transfusion requirements, and postoperative complications including intra-abdominal abscess and pancreatic fistula (all P < 0.02). Factors not associated with higher readmission rates included advanced age, body mass index, cardiovascular/pulmonary comorbidities, diabetes, steroid use, Whipple type (standard vs pylorus preserving PD), preoperative endobiliary stenting, and vascular reconstruction.
  
  
  CONCLUSIONS
  These multi-institutional data represent a large experience of PD without the biases typically of single center studies. Factors related to infection, nutritional status, and delayed gastric emptying were the most common reasons for readmission after PD. Postoperative complications including pancreatic fistula predicted higher rates of readmission.
authors.affiliation: Central Pancreas Consortium, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA. ahmadsy@uc.edu
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.forename: Sanjeet S
authors.initials: SS
authors.lastname: Grewal
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Sameer H
authors.initials: SH
authors.lastname: Patel
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentram
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Emily R
authors.initials: ER
authors.lastname: Winslow
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.forename: Robert C
authors.initials: RC
authors.lastname: Martin
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Baker
authors.forename: Nipun B
authors.initials: NB
authors.lastname: Merchant
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Parikh
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis