title: High readmission rates after surgery for chronic pancreatitis.
abstract: BACKGROUND
  Readmission after complex gastrointestinal surgery is a frequent occurrence that burdens the health care system and leads to increased cost. Recent studies have demonstrated 30- and 90-day readmission rates of 15% and 19%, respectively, following pancreaticoduodenectomy. Given the psychosocial issues often associated with chronic pancreatitis, we hypothesized that readmission rates following surgery for chronic pancreatitis would be higher than previously reported for pancreaticoduodenectomy.
  
  
  METHODS
  We retrospectively reviewed patients undergoing surgery for chronic pancreatitis at a single institution between 2001 and 2013. Patients in this cohort underwent pancreaticoduodenectomy, Berne, Beger, or Frey procedures. Readmission to a primary or secondary hospital was evaluated at both 30 and 90 days after discharge. Multivariate logistic regression analysis was performed to identify factors associated with readmission.
  
  
  RESULTS
  The records of 111 patients were evaluated, of which 69 (62%) underwent duodenal-preserving pancreatic head resection (Berne, Beger, or Frey), while the remaining 42 (38%) underwent pancreaticoduodenectomy. Within the duodenal-preserving pancreatic head resection arm, readmission rates at 30 and 90 days were 30.4% and 43.5%, respectively. Readmission rates following pancreaticoduodenectomy were similar with 33.3% at 30 days and 40.5% at 90 days. The most common reasons for readmission were pain control, infectious complications, and recurrent pancreatitis. On multivariate analysis, wound infection during the initial hospital stay was a predictor of readmission at both 30 and 90 days (P = .02).
  
  
  CONCLUSIONS
  To our knowledge, our data represent the first report demonstrating very high readmission rates after surgery for chronic pancreatitis, more than double the previous rates reported for pancreaticoduodenectomy. This cohort of patients requires extensive discharge planning focused on pain control, nutritional optimization, and close postoperative monitoring.
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Fisher
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Hanseman
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Gastroenterology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Milton T
authors.initials: MT
authors.lastname: Smith
authors.affiliation: Department of Gastroenterology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Nathan
authors.initials: N
authors.lastname: Schmulewitz
authors.affiliation: Department of Radiology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Kyran A
authors.initials: KA
authors.lastname: Choe
authors.affiliation: Department of Pathology, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.affiliation: Department of Surgery, University of Cincinnati Pancreatic Disease Center, University of Cincinnati Medical Center, Cincinnati, OH. Electronic address: ahmadsy@uc.edu.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D050500:Pancreatitis, Chronic / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors