title: Risk stratification for readmission after major hepatectomy: development of a readmission risk score.
abstract: BACKGROUND
  Hospital readmission is becoming a quality measure, despite poor understanding of the risks of readmission. This study examines readmission risk factors after major hepatectomy and develops a predictive model.
  
  
  METHODS
  A retrospective review was performed on patients who had undergone major hepatectomy at 1 of 3 academic centers between the years 2000 and 2012. Clinicopathologic and perioperative data were analyzed for risk factors of 90-day readmission using logistic regression. A readmission risk score was developed and validated in a separate validation set to determine its predictive value.
  
  
  RESULTS
  Of 1,184 hepatectomies performed, 17.3% of patients were readmitted within 90 days. Factors associated with readmission include operative blood loss (odds ratio [OR] = 1.00; 95% CI, 1.000-1.001), any postoperative complication (OR = 4.3; 95% CI, 1.8-10.4), a major postoperative complication (OR = 5.7; 95% CI, 3.2-10.2), postoperative pulmonary embolism (OR = 12.2; 95% CI, 1.9-78.4), no postoperative blood transfusion (OR = 3.3; 95% CI, 1.7-6.2), surgical site infection (OR = 5.3; 95% CI, 2.9-10.0), and post-hepatectomy hyperbilirubinemia (OR = 1.1; 95% CI, 1.1-1.2). A scoring system based on these risk factors accurately predicted readmission in the validation cohort. A score of >20 points had a positive predictive value of 30.8% and negative predictive value of 95.6%, and a score >50 had a positive predictive value of 50.9% and negative predictive value of 87.7%. This risk score accurately stratifies readmission risk.
  
  
  CONCLUSIONS
  The risk of hospital readmission within 90 days after major hepatectomy is high and is reliably predicted with a novel scoring system.
authors: Hiram C Polk Jr, MD Department of Surgery, University of Louisville, Louisville, KY.
authors: Michael E
authors: ME
authors: Egger
authors: Department of Surgery, Emory University, Atlanta, GA.
authors: Malcolm H
authors: MH
authors: Squires
authors: Department of Surgery, Emory University, Atlanta, GA.
authors: David A
authors: DA
authors: Kooby
authors: Department of Surgery, Emory University, Atlanta, GA.
authors: Shishir K
authors: SK
authors: Maithel
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors: Clifford S
authors: CS
authors: Cho
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors: Sharon M
authors: SM
authors: Weber
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
authors: Emily R
authors: ER
authors: Winslow
authors: Hiram C Polk Jr, MD Department of Surgery, University of Louisville, Louisville, KY.
authors: Robert C G
authors: RC
authors: Martin
authors: Hiram C Polk Jr, MD Department of Surgery, University of Louisville, Louisville, KY.
authors: Kelly M
authors: KM
authors: McMasters
authors: Hiram C Polk Jr, MD Department of Surgery, University of Louisville, Louisville, KY. Electronic address: Charles.scoggins@louisville.edu.
authors: Charles R
authors: CR
authors: Scoggins
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology