title: Readmission after pancreatic resection: causes and causality pattern.
abstract: BACKGROUND
  Readmission rates have been targeted for cost/reimbursement control. Our goal was to identify causes for readmission and delineate the pattern of early and late readmission.
  
  
  METHODS
  Between 2011 and 2012, a total of 490 patients underwent pancreaticoduodenectomy, distal pancreatectomy or central pancreatectomy. Logistic regression was used to identify predictors of readmission. K-medoids clustering was performed to identify the major readmission subgroups.
  
  
  RESULTS
  Median postoperative length of stay (LOS) was 7 days, and the 30- and 90-day readmission rates were 23 and 29 %, respectively. The most common cause for 30-day readmissions was procedure-related infections (58 %), while the most common cause for 31-90-day readmissions was failure to thrive and chemotherapy-related symptoms (38 %). Independent predictors of 30-day readmissions were central pancreatectomy, discharge with a drain, pancreatic duct <3 mm, previous abdominal surgery, and postoperative LOS. Independent predictors for 31-90-day readmissions were age and preoperative serum carcinoembryonic antigen. Cancer-related covariates were more common in the 31-90-day readmission group. Postoperative carbohydrate antigen 19-9 levels were twofold higher in the 31-90-day readmission group compared with the no readmission group (p = 0.03). K-medoids clustering identified a subgroup where 74 % of readmissions occur at a median of 7 days after discharge.
  
  
  CONCLUSIONS
  Readmissions after pancreatic operations are procedure-related in the first 30 days, but those after this period are influenced by the natural history of the underlying diagnosis. The readmission penalty policy should account for the timing of readmission and the natural history of the underlying disease and procedure. Early follow-up for patients at high risk for readmission may minimize early readmissions.
authors.affiliation: Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Ser Yee
authors.initials: SY
authors.lastname: Lee
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Groeger
authors.forename: T
authors.initials: T
authors.lastname: Peter Kingham
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016577:Pancreaticoduodenectomy; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult