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RISK FACTORS ASSOCIATED WITH 90-DAY READMISSION AFTER PANCREATIC RESECTION Kelly Roth*1, Amir A. Khan1, Steven Scaife2, Sabha Ganai1,3 1Department of Surgery, Southern Illinois University, Springfield, IL; 2Center for Clinical Research, Southern Illinois University, Springfield, IL; 3Office for Population Science and Policy, Southern Illinois University, Springfield, IL
Introduction: Measures to reduce excess readmissions via Medicare payment adjustment have been recently initiated for a limited group of diseases. Despite improvements in postoperative management, pancreatectomy has high morbidity which likely drives readmissions. The purpose of this study is to compare 90-day readmission rates of patients undergoing proximal pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). We hypothesized that patients undergoing DP have lower readmission rates than PD. Methods: A retrospective analysis of the National Readmission Database (2013-2014) was performed to identify patients who were readmitted within 90 days following pancreatic resection. Data were collected from hospital admissions between January and September of each year to allow for complete 90 day follow up on all included patients (n=9,637). Demographics, Charlson Comorbidity Index (CCI), pathology, post-operative complications and discharge status were reviewed. The primary outcome was rate of 90-day readmissions. Results: A total of 6,040 patients underwent PD and 3,597 underwent DP. PD was performed more frequently in males compared to DP (52.8% vs. 44.7%; p<0.0001). Patients receiving PD were more likely to have adenocarcinoma in comparison to DP (78.9% vs. 43.0%) and less likely to have surgery performed for neuroendocrine tumors (PNETs; 4.9% vs. 16.8%) or benign indications (16.2% vs. 40.1%; p<0.0001). Overall 90-day readmission rates were higher after PD (31.2% vs 28.7%; p = 0.0009). More comorbid conditions were noted in readmitted patients after PD (CCI 3.5±2.1 vs. 3.3±2.1; p<0.003) and DP (2.6±2.3 vs. 2.3±2.1; p<0.001) in comparison to non-readmitted patients. Pathology did not influence risk of readmission after PD, while patients with PNETs who underwent DP were less likely to be readmitted compared to those with adenocarcinomas (p<0.001). VTE were noted in 63 (3.3%) of readmissions after PD and 35 (3.4%) of readmissions after DP. Patients with private insurance were less likely to be readmitted after both PD and DP in comparison to Medicare/Medicaid (p<0.001). Patients initially discharged to a skilled nursing facility or rehab were more likely to be readmitted in comparison to patients discharged home after both PD and DP (<0.001). Total charges were $32K greater after readmission for PD and $26K greater after readmission for DP in comparison with non-readmitted patients. Conclusions: While our data supports the hypothesis that DP has lower 90-day readmissions, both procedures have rather high readmission rates comprising 3 out of every 10 cases, with minimal impact by academic facility type. Analysis is limited by selection bias and uncontrolled confounders. Further study is warranted to assess if these readmissions can be predicted or prevented.
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