title: A novel risk scoring system reliably predicts readmission after pancreatectomy.
abstract: BACKGROUND
  Postoperative readmissions have been proposed by Medicare as a quality metric and can impact provider reimbursement. Because readmission after pancreatectomy is common, we sought to identify factors associated with readmission to establish a predictive risk scoring system.
  
  
  METHODS
  A retrospective analysis of 2,360 pancreatectomies performed at 9 high-volume pancreatic centers between 2005 and 2011 was performed. Forty-five factors strongly associated with readmission were identified. To derive and validate a risk scoring system, the population was randomly divided into 2 cohorts in a 4:1 fashion. A multivariable logistic regression model was constructed and scores were assigned based on the relative odds ratio (OR) of each independent predictor. A composite Readmission after Pancreatectomy (RAP) score was generated and then stratified to create risk groups.
  
  
  RESULTS
  Overall, 464 (19.7%) patients were readmitted within 90 days. Eight pre- and postoperative factors, including earlier MI (OR = 2.03), American Society of Anesthesiologists class ≥ 3 (OR = 1.34), dementia (OR = 6.22), hemorrhage (OR = 1.81), delayed gastric emptying (OR = 1.78), surgical site infection (OR = 3.31), sepsis (OR = 3.10), and short length of stay (OR = 1.51) were independently predictive of readmission. The 32-point RAP score generated from the derivation cohort was highly predictive of readmission in the validation cohort (area under the receiver operating curve = 0.72). The low-risk (0 to 3), intermediate-risk (4 to 7), and high-risk (>7) groups correlated with 11.7%, 17.5%, and 45.4% observed readmission rates, respectively (p < 0.001).
  
  
  CONCLUSIONS
  The RAP score is a novel and clinically useful risk scoring system for readmission after pancreatectomy. Identification of patients with increased risk of readmission using the RAP score will allow efficient resource allocation aimed to attenuate readmission rates. It also has potential to serve as a new metric for comparative research and quality assessment.
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Vicente
authors: V
authors: Valero
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Joshua C
authors: JC
authors: Grimm
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Arman
authors: A
authors: Kilic
authors: Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: Russell L
authors: RL
authors: Lewis
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Jeffrey J
authors: JJ
authors: Tosoian
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Jin
authors: J
authors: He
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: James F
authors: JF
authors: Griffin
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: John L
authors: JL
authors: Cameron
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors: Matthew J
authors: MJ
authors: Weiss
authors: Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA.
authors: Charles M
authors: CM
authors: Vollmer
authors: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: cwolfga2@jhmi.edu.
authors: Christopher L
authors: CL
authors: Wolfgang
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors