Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them?: a 10-year contemporary experience with 1,173 patients at the Massachusetts General Hospital.

摘要: The morbidity and mortality of pancreaticoduodenectomy (PD) have significantly decreased over the past decades to point that they are no longer sole indicators quality safety. In recent times, hospital readmission is increasingly used as a metric for surgical performance has direct implications on health-care costs. We sought delineate natural history predictive factors readmissions after PD. clinicopathologic long-term follow-up data 1,173 consecutive patients who underwent PD between August 2002 2012 at Massachusetts General Hospital were reviewed. NSQIP database was linked with our clinical supplement perioperative data. Readmissions unrelated index admission omitted. identified 173 (15 %) required within study period. rate higher in second half decade when compared first (18.6 vs 12.3 %, p = 0.003), despite stable 7-day median length stay. Readmitted analyzed against those without demographics tumor pathology both groups did not differ significantly. multivariate logistic regression analysis, pancreatic fistula (18.5 11.3 %, OR 1.86, p = 0.004), multivisceral resection time (3.5 0.6 %, 4.02, p = 0.02), initial stay >7 days (59.5 42.5 %, 1.57, p = 0.01), ICU admissions (11.6 3.4 %, 2.90, p = 0.0005) independently associated readmissions. There postoperative biochemical variables Fifty percent (n = 87) occurred 7 days from operative discharge. reasons immediate (≤7 days) nonimmediate (>7 days) differed; ileus, delayed gastric emptying, pneumonia more common early readmissions, whereas wound infection, failure thrive, intra-abdominal hemorrhage late incidences due fistulas abscesses equally distributed frames. frequency 15 % been uptrend last decade. complexity Further efforts should be centered preventing which constitute all