SSAT - INDEX VERSUS NON-INDEX HOSPITAL READMISSION FOLLOWING HEPATO-PANCREATO-BILIARY SURGERY

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INDEX VERSUS NON-INDEX HOSPITAL READMISSION FOLLOWING HEPATO-PANCREATO-BILIARY SURGERY
Eliza W. Beal, Fabio Bagante, Qinyu Chen, Ozgur Akgul, Katiuscha Merath, Timothy M. Pawlik^*
Surgery, The Ohio State Wexner Medical Center, Columbus, OH

Introduction: The Center for Medicare and Medicaid Services (CMS) has identified readmission as an important quality metric. With an increased emphasis on regionalization of complex hepato-pancreato-biliary (HPB) surgery to high-volume centers, care of readmitted HPB patients may be fragmented if readmission occurs at a non-index hospital. We sought to define the proportion of HPB readmissions, as well as evaluate outcomes, that occur at an index- versus non-index hospitals.

Methods: The National Readmissions Database (NRD) was used to identify patients who underwent major HPB surgery between 2010-2014. Factors associated with readmission at 30- and 90-days at index- versus non-index hospitals were analyzed. Differences in mortality and subsequent readmission were analyzed among patients re-admitted to index- versus non-index hospitals.

Results: A total of 49,080 patients underwent HPB surgery (liver: n=27,081, 55%; pancreas: n=14,787, 30%; biliary: n= 7,212, 15%). Overall, 6,643 (14%) and 11,709 (24%) patients were readmitted within 30- and 90-days, respectively. Among all first readmissions, 18% and 21% were to a non-index hospital within the first 30- and 90-days, respectively (Figure). On multivariable analysis, factors associated with readmission to a non-index hospital included age > 60 (OR 1.19, 95% CI 1.05-1.34), >2 pre-operative medical comorbidities (OR 1.32, 95% CI 1.09-1.61), and pancreas cancer diagnosis (OR 1.40, 95% CI 1.15-1.71)(all p<0.05). On multivariable analysis, after adjusting for other risk factors, patients readmitted to a non-index hospital tended to have an overall higher odds of mortality (OR 1.25, 95% 0.97-2.18, p=0.09).

Conclusions: Roughly 1 in 5 patients were readmitted to a non-index hospital where the initial HPB operation had not taken place. Readmission to a non-index hospital was associated with a tendency toward higher overall in-hospital mortality. The impact of regionalization of HPB care relative to site of subsequent readmission may have important implications for patients.

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