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Risk Factors for 30-Day Readmissions After Hepatectomy: Analysis of 2,444 Patients From the ACS-NSQIP Database
Sooyeon Kim^*, Erin Maynard, Malay Shah, Michael Daily, Ching-Wei Tzeng, Daniel Davenport, Roberto Gedaly
Department of Surgery, University of Kentucky College of Medicine, Lexington, KY

Background: With optimization of surgical technique and perioperative care, the mortality rate from hepatectomy has declined substantially over the last two decades. Readmission rate has been proposed as a primary endpoint for quality assurance in addition to the traditional measures of morbidity and mortality. The aim of this study was to identify risk factors associated with unplanned readmissions following hepatectomy. Method: Patients who underwent hepatectomies between January-December 2011 were identified using the ACS-NSQIP procedure-specific database. A multivariable logistic regression analysis was performed to determine predictors of unplanned readmissions related to the procedure (UPRR) within 30 days. Result: Unplanned rehospitalization occurred in 10.5% of patients undergoing hepatectomy in this national cohort. On multivariate analysis, transfusion within 72 hrs (odds ratio [OR] 1.74, p<0.001), complexity of procedure (extended, OR 1.84, p=0.004; right hepatectomy, OR 1.66, p=0.003), and longer operative time (> median 320 min, OR 2.43, p<0.001) were independent perioperative predictors of UPRR. Independent preoperative risk factors included elevated alkaline phosphatase (OR 1.45, p=0.017), hypoalbuminemia (OR 1.30, p=0.036), and bleeding disorder (OR 1.72, p=0.051). Conclusion: Transfusion, complexity of procedure, and duration of operation were the strongest predictors of unplanned readmissions after hepatectomy. These risk factors help identify patients at greater risk of unplanned readmission in order to optimize preoperative screening strategies and preventive measures at time of discharge.

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