title: Reducing Readmissions after Pancreatectomy: Limiting Complications and Coordinating the Care Continuum.
abstract: BACKGROUND
  Recent analyses of gastrointestinal operations document that complications are a key driver of readmissions. Pancreatectomy is a high outlier with respect to readmission. This analysis sought to determine if a multifactorial approach could reduce readmissions after pancreatectomy.
  
  
  METHODS
  From 2007 to 2012, the number of patients readmitted by 30 days after pancreaticoduodenectomy, and distal and total pancreatectomy was measured. Steps to decrease readmissions were implemented independently at 1-year intervals; these efforts included strategies to reduce complications, creation of a Readmissions Team with a "discharge coach," increased use of home health, preferred relationships with post-acute care facilities, and the adoption of "Project RED" (Re-Engineered Discharge). The ACS NSQIP was used to track 30-day outcomes for all pancreatic resections. The University HealthSystem Consortium was used to determine length of stay index.
  
  
  RESULTS
  Over 5 years, 1,163 patients underwent proximal (66%), distal (32%), or total pancreatectomy (2%). The observed 30-day mortality was 2.9% for the study period, and the length of stay index (observed/expected days) was 1.10. Neither varied significantly over time. However, 30-day morbidity decreased from 57% to 46%, and proportion of patients with 30-day all-cause readmissions decreased from 23.0% to 11.5% (p = 0.001).
  
  
  CONCLUSIONS
  All-cause 30-day readmissions after pancreatectomy decreased without increasing length of stay. Efforts by surgeons to decrease complications and an increased emphasis on coordination of care may be useful for reducing readmissions.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA. Electronic address: Henry.pitt@tuhs.temple.edu.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
authors.affiliation: Department of Nursing, Indiana University Health, Indianapolis, IN.
authors.forename: E Molly
authors.initials: EM
authors.lastname: Kilbane
authors.affiliation: Department of Nursing, Indiana University Health, Indianapolis, IN.
authors.forename: Alisha N
authors.initials: AN
authors.lastname: George-Minkner
authors.affiliation: Clinical Decision Support, Indiana University Health, Indianapolis, IN.
authors.forename: Beth
authors.initials: B
authors.lastname: Brand
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors