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Readmission After Liver Resection for Intrahepatic Cholangiocarcinoma: a Multi-Institutional Analysis
Gaya Spolverato^*1, Alessandra Vitale², Sorin Alexandrescu³, Hugo Marques⁴, Luca a. Aldrighetti^{5, 6}, T. Clark Gamblin⁶, Shishir K. Maithel⁷, Carlo Pulitano⁸, Todd W. Bauer⁹, Feng Shen¹⁰, George a. Poultsides¹¹, J Wallis Marsh¹², Timothy M. Pawlik<sup>1

1</sup>Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; ²University of Padua, Padua, Italy; ³Fundeni Clinical Institute, Bucharest, Romania; ⁴Curry Cabral Hospital, Lisbon, Portugal; ⁵HRS, Milan, Italy; ⁶Medical College of Wisconsin, Milwaukee, WI; ⁷Emory University, Atlanta, GA; ⁸7University of Sydney, Sydney, NSW, Australia; ⁹University of Virginia, Charlottesville, VA; ¹⁰Eastern Hepatobiliary Surgery Hospital, Shanghai, China; ¹¹San Raffaele, Stanford, CA; ¹²University of Pittsburgh Medical Center, Pittsburgh, PA

Background: Readmission after hospitalization is increasingly being used as a quality metric in the healthcare system. The objective of the current study was to define the incidence of 30-day readmission after hepatic resection for intrahepatic cholangiocarcinoma (ICC). In particular, we sought to identify risk factors associated with a higher risk of readmission among patients undergoing resection for ICC.
Methods: Patients who underwent hepatic resection for ICC at 12 major hepatobiliary centers in the United States, Europe, Australia and Asia between 1990-2013 were identified. 30-day readmission and clinicopathologic characteristics associated with higher risk of readmission were examined.
Results: Among 602 patients, median age was 60.1 years and the majority of patients were male (52.9%); 401 (68.3%) patients underwent a major hepatectomy. A total of 256 (43.3%) patients experienced at least one postoperative complication (minor: 62.1% vs. major: 37.9%). Median length-of-stay during the index hospitalization was 9 days (IQR, 6-15). Overall 30-day readmission was 7.8% (n=47). Risk factors associated with readmission on multivariable analysis included preoperative jaundice (OR 2.45, 95% CI 1.17-5.12, P=0.017) and the presence of a major complication (OR 3.38, 95% CI 1.74-6.61, P<0.001). In fact, 95.7% of readmitted patients had experienced a post-operative complication versus only 38.8% of non-readmitted patients (P<0.001). Among patients who were readmitted, repeat hospitalization was associated with a median LOS of 6.5 days (IQR 4.0-11.5) and 1 patient died during readmission.
Conclusions: Readmission after hepatic resection for ICC occurred in roughly 1 in 13 patients. Patients with preoperative jaundice and those who experienced a complication had over a 2-fold higher risk of being readmitted.

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