Society for Surgery of the Alimentary Tract
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Artem Boyev*, Ahad M. Azimuddin, Jessica E. Maxwell, Morgan L. Bruno, Whitney L. Dewhurst, Elsa M. Arvide, Laura R. Prakash, Timothy E. Newhook, Michael P. Kim, Naruhiko Ikoma, Rebecca A. Snyder, Jeffrey E. Lee, Matthew Katz, Ching-Wei D. Tzeng
Surgical Oncology, The University of Texas MD Anderson Cancer Center Division of Surgery, Houston, TX

We previously demonstrated that risk-stratified pancreatectomy care pathways are associated with decreased opioid use, earlier drain removal, and decreased index hospitalization length of stay (LOS). However, readmission rates have remained constant despite these interventions. The purpose of this study was to evaluate reasons for readmission and identify opportunities to refine postoperative care to reduce readmission rates.

We performed a single-institution retrospective cohort study of consecutive patients who underwent pancreatectomy from October 2016 - April 2022. Complications were prospectively graded in a biweekly faculty and advanced practice provider meeting using the ACCORDION system. Reasons, timing, and treatments associated with 90-day readmissions were analyzed by further review of the electronic health record. Primary reason for readmission was classified, in order of priority, as technical, infectious, medical/metabolic, and other.

849 patients underwent 541 (64%) pancreatoduodenectomies, 285 (34%) distal pancreatectomies, and 23 (3%) other resections. There were 84% (713/849) open and 16% (136/849) minimally invasive procedures. 25% (212/849) of all patients were readmitted. Among the 212 readmitted patients, readmission occurred on median day 8 (interquartile range, IQR 3-17) after discharge with LOS of median 4 days (IQR 2-8). Approximately 26% (56/212) were early readmissions (within 3 days of discharge), and 26% (55/212) required multiple readmissions. 90% (191/212) of readmissions were for complications related to surgery. Among patients readmitted for surgical complications, the primary reason was technical in 48% (92/191), infectious in 19% (37/191), metabolic/medical in 26% (50/191) and other in 6% (12/191) patients. 71% (91/129) of patients with technical or infectious complications required interventional procedures. Of patients readmitted for metabolic/medical reasons, 82% (41/50) received no intervention or only required additional consultations (most commonly nutrition, pain management, and endocrine). Median LOS was longer for technical/infectious vs. metabolic/medical readmissions (5 vs. 4 days, p=0.025). Of the 53 early readmissions due to surgical complications, 64% (34/53) required invasive intervention, while 30% (16/53) required no intervention or only additional consultations.

Technical and infectious complications account for approximately two-thirds of surgical readmissions after pancreatectomy, but one-fourth are readmitted for metabolic/medical reasons. Of these, only one-third require invasive interventions or parenteral nutrition. Adding capacity for same-day imaging, in-clinic consultations, intravenous fluid administration, and urgent care centers distinct from emergency rooms may be practical measures for reducing readmissions after pancreatectomy.

Table 1: Interventions by primary reason for re-admission. Patients may have multiple interventions. Abbreviations: IR= interventional radiology, TPN= total parenteral nutrition, LOS= length of stay, IQR= interquartile range.

Figure 1: Interventions by primary reason for re-admission. Patients may have multiple interventions. Interventions in bar graphs listed in order they appear in the legend. Abbreviations: IR= interventional radiology, TPN= total parenteral nutrition.

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