The hospital readmission rate within 30 days of discharge was approximately 20% for patients with cancer undergoing pancreatectomy, according to results of a large retrospective study published in the Journal of Hepato-Biliary-Pancreatic Sciences.
Although surgery represents the only potentially curative approach for patients with pancreatic cancer, only approximately 20% of those with the disease are surgical candidates. Furthermore, the surgical procedures undertaken, such as pancreaticoduodenectomy (ie, Whipple procedure), are associated with technical challenges and a relative high risk of complications. Hence, the identification of modifiable risk factors associated with hospital readmission following postsurgical discharge has the potential to increase the quality of care received by these patients.
This cross-sectional study used a large statewide database as a source of demographic and clinical data for adult patients who underwent pancreatectomy due to a malignancy from 2005 to 2011. The main outcome measure of the study was the rate of all-cause 30-day readmission rates defined as “any unplanned admission to a hospital within 30 days of discharge from the index admission.”
The study cohort of 4262 patients had a median age of 66 years, with 65.5%, 5.5%, and 13.6% of patients classified as white, black, and Hispanic, respectively. The majority of patients were insured through Medicare (50.6%) or private insurance (40.1%), and 61.7%, 12.9%, and 24.8% of patients were discharged to routine care, a skilled nursing facility, and home health care, respectively.
Some of the key study findings were as follows:
- Median length of postsurgical hospitalization was 11 days;
- Over the 7-year period represented by the study, no significant change was observed in the rate of 30-day hospital readmission (range, 18.1%-23.6%; P =.20);
- Approximately 40% of patients experienced 1 or more complications following surgery, with infection identified as the most common postsurgical complication;
- Readmission rates were 22.9% for those with a complication compared with 19.8% for those without a complication (P =.007);
- Discharge to a skilled nursing facility (29.7%) was associated with a higher 30-day postdischarge readmission rate compared with routine discharge (19.4%; P <.001);
- Nearly three-quarters of hospital readmissions occurred within 15 days following postsurgical discharge, with one-third of those occurring within the first 5 days.
In addition, factors associated with an increased risk of hospital readmission within 30 days of postsurgical discharge on multivariate analysis included Medicare insurance coverage compared with private insurance (odds ratio [OR], 1.26; P =.043), Hispanic race/ethnicity compared with white (OR, 1.26; P =.046), the presence of chronic anemia (OR, 1.21; P =.047), discharge to a skilled nursing facility compared with home (OR, 1.63; P <.001), postoperative hospitalization duration of 12 to 21 days compared with stays of 11 days or less (OR, 1.23; P =.027), postoperative hospitalization duration of 22 days or more compared with stays of 11 days or less (OR, 1.39; P =.008).
Of note, women were less likely than men to be readmitted to the hospital within 30 days of discharge for the index surgery (OR, 0.74; P <.001), and patient age was not associated with likelihood of hospital readmission.
“Preoperative optimization, minimizing postoperative complications, and assuring patients have been evaluated by a multidisciplinary team may reduce the readmission rate,” the study authors commented in their concluding remarks.
Hue JJ, Navale S, Schiltz N, Koroukian SM, Ammori JB. Factors affecting readmission rates after pancreatectomy [published online January 20, 2020]. J Hepatobiliary Pancreat Sci. doi: 10.1002/jhbp.706