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Introduction: The morbidity and mortality of pancreaticoduodenectomy (PD) have significantly decreased over the past decades to the point that they are no longer the sole indicators of quality and safety. In recent times, hospital readmission is increasingly used as a quality metric for surgical performance, and has direct implications on health care costs. We sought to delineate the natural history and predictive factors of readmissions after PD.
Methods: The clinicopathologic and long-term follow-up data of 1173 consecutive patients who underwent PD between August 2002 and August 2012 at a single institution were reviewed. The NSQIP database was linked with our clinical database to supplement perioperative data. Readmissions unrelated to the index admission were omitted.
Results: We identified 173 (16%) patients who required readmission after PD within the study period. The readmission rate was higher in the 2nd half of the decade when compared to the 1st half (18.6% vs 12.3%, p=0.003), despite a stable 7 day median length of stay. Readmitted patients were analyzed against those without readmissions after PD. The demographics and tumor pathology of both groups did not differ significantly. In the multivariate logistic regression analysis, preoperative albumin ≤3.5 (19% vs 11%, OR 1.6, p=0.046), multi-visceral resection at time of PD (3% vs 0.6%, OR 11.9, p=0.031) and a length of initial hospital stay > 7days (59% vs 43%, OR 1.6, p=0.043) were independently associated with readmissions. There were no postoperative biochemical variables that were predictive of readmissions. Fifty percent (n=87) of the readmissions occurred within 7 days from initial operative discharge. The reasons for early and late (> 7days) readmissions differed; ileus, delayed gastric emptying and pneumonia were more common in early readmissions, whereas wound infection, failure to thrive and intraabdominal hemorrhage were associated with late readmissions. The incidence of readmissions due to pancreatic fistulas and intraabdominal abscesses were equally distributed between both time frames.
Conclusion: The frequency of readmission after PD is 16%, and has been on the uptrend over the last decade. Poor preoperative nutritional status and the complexity of initial resection were independently associated with hospital readmissions after PD. Further efforts should be centered on preventing early readmissions, which constitute half of all readmissions.