title: Examining reoperation and readmission after hepatic surgery.
abstract: BACKGROUND
  Although the perioperative mortality from hepatic resection has improved considerably, this procedure is still associated with substantial morbidity and resource use. The goal of this investigation was to characterize the incidence, patterns, and risk factors for early reoperation and readmission after hepatectomy.
  
  
  METHODS
  Perioperative outcomes of 1,281 patients undergoing hepatic resection at an academic center from 1996 to 2009 were analyzed. The indications for early reoperation and readmission (90 days) were reviewed. Multivariate logistic regression analysis was performed to determine variables associated with reoperation and readmission. A scoring system was generated to predict the need for readmission after hepatectomy.
  
  
  RESULTS
  Eighty-seven patients (6.8%) required reoperation. The perioperative mortality in patients requiring reoperation was significantly higher than for those not requiring reoperation (23.0% vs 3.4%; p < 0.001). Variables associated with reoperation included male sex, performance of concomitant major nonhepatic procedures, and greater intraoperative blood loss. One hundred and eighty-four patients (14.4%) required readmission. Variables associated with readmission included major hepatectomy, development of major postoperative complications, and index hospitalization >7 days. A Readmission Prediction Score ranging from 0 to 4 was generated and directly correlated with need for readmission.
  
  
  CONCLUSIONS
  In the current era of hepatic surgery, early reoperation and readmission remain relatively frequent. As we care for patients who are increasingly receiving regionalized care far from home, we must be mindful of patients at increased risk for readmission. The development of strategies to minimize the complications that necessitate reoperation and readmission is critical to improving patient care.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. andrew.barbas@duke.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Barbas
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.forename: Mohan K
authors.initials: MK
authors.lastname: Mallipeddi
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lidsky
authors.forename: Srinevas K
authors.initials: SK
authors.lastname: Reddy
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: White
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Clary
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012086:Reoperation / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors