title: Readmission after pancreatic resection is not an appropriate measure of quality.
abstract: BACKGROUND
  Hospital readmission has been proposed as a metric for quality of medical and surgical care. We examined our institutional experience with readmission after pancreatic resection, and assessed factors predictive of readmission.
  
  
  METHODS
  We reviewed 787 pancreatic resections performed at a single institution between 2006 and 2010. Univariate and multivariate logistic regression models were used to assess the relationships between preoperative and postoperative characteristics and readmission. Reasons for hospital readmission were examined in detail.
  
  
  RESULTS
  We found the 30-day readmission rate after pancreatic resection to be 11.6 %. In univariate analysis, young age, pancreaticoduodenectomy versus other operations, open versus laparoscopic technique, fistula formation, the need for reoperation, and any complication during the index hospitalization were predictive of readmission. In multivariate analysis, only young age and postoperative complication were predictive of readmission. Vascular resection, postoperative ICU care, length of stay, and discharge disposition were not associated with readmission. The most common reasons for readmission were leaks, fistulas, abscesses, and wound infections (45.1 %), delayed gastric emptying (12.1 %), venous thrombosis (7.7 %), and GI bleeding (7.7 %).
  
  
  CONCLUSIONS
  We found the vast majority of readmissions after pancreatic resection were to manage complications related to the operation and were not due to poor coordination of care or poor discharge planning. Because evidence-based measures to prevent these surgical complications do not exist, we cannot support the use of readmission rates themselves as a quality indicator after pancreatic surgery.
authors.affiliation: Department of Surgery, Columbia University Medical Center and the New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Irmina
authors.initials: I
authors.lastname: Gawlas
authors.forename: Monica
authors.initials: M
authors.lastname: Sethi
authors.forename: Megan
authors.initials: M
authors.lastname: Winner
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.forename: James L
authors.initials: JL
authors.lastname: Lee
authors.forename: Beth A
authors.initials: BA
authors.lastname: Schrope
authors.forename: John A
authors.initials: JA
authors.lastname: Chabot
authors.forename: John D
authors.initials: JD
authors.lastname: Allendorf
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000367:Age Factors; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology; D005746:Gastric Emptying; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology