title: Factors predictive of readmission after hepatic resection for hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatic resection is associated with substantial morbidity and resource use. To contain costs and improve outcomes, recent health care regulations focus on reducing hospital readmissions while using readmission rates as a quality measure. The goal of this investigation was to characterize the incidence, patterns, and risk factors for readmission after resection for hepatocellular carcinoma.
  
  
  METHODS
  Patient demographics, operative factors, and perioperative outcomes of 245 patients undergoing hepatic resection at an academic center from 2000 to 2012 were reviewed retrospectively. Factors associated for readmission within 90 days of operation were identified through univariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Forty-six patients (18.7%) required hospital readmission. Univariate analysis identified American Society of Anesthesiologists class, preoperative Model for End-stage Liver Disease score and total bilirubin, preexisting vascular disease, acute renal failure, bile leak, peak postoperative total bilirubin, and intraabdominal infection as factors associated with readmission. Intraabdominal infection, postoperative renal failure, and a history of vascular disease were found to be significant on multivariate analysis. Overall, intraabdominal infection was the strongest predictor for readmission.
  
  
  CONCLUSIONS
  Early readmission after hepatectomy remains relatively common. Postoperative complications and patient comorbidities are the dominant factors in readmission, and we must be mindful of those patients at increased risk for readmission.
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Kimbrough
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Agle
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Scoggins
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Eric G
authors.initials: EG
authors.lastname: Davis
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.affiliation: Hiram C. Polk Jr., MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY. Electronic address: Christopher.Jones.1@louisville.edu.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors