Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2015

01-11-2015 | Healthcare Policy and Outcomes

Readmission After Pancreaticoduodenectomy: The Influence of the Volume Effect Beyond Mortality

Authors: Jeffrey M. Sutton, MD, Gregory C. Wilson, MD, Koffi Wima, MS, Richard S. Hoehn, MD, R. Cutler Quillin III, MD, Dennis J. Hanseman, PhD, Ian M. Paquette, MD, Jeffrey J. Sussman, MD, Syed A. Ahmad, MD, Shimul A. Shah, MD, MCHM, Daniel E. Abbott, MD

Published in: Annals of Surgical Oncology | Issue 12/2015

Login to get access

Abstract

Background

As increased focus is placed on quality of care in surgery, readmission is an increasingly important metric by which hospital and surgeon quality is measured. For complex pancreatic surgery, we hypothesized that increased pancreaticoduodenectomy (PD) volume may mitigate readmission rates.

Methods

The University Healthsystems Consortium database was queried for all patients (n = 9805) undergoing PD from 2009 to 2011. Hospitals were stratified into quintiles based on number of cases performed annually. Univariate and multivariate logistic regression analyses were performed to identify factors associated with 30-day readmission.

Results

The 30-day readmission rate for patients undergoing PD was 19.1 %. Stratified by volume, hospitals performing the highest two quintiles of PDs annually (≥56 cases) had a significantly lower unadjusted readmission rate than those hospitals performing the lowest quintile (n ≤ 23 cases; 16.7 and 18.0 % vs. 20.9 %, p < 0.05). On univariate analysis, readmitted patients tended to have higher severity of illness (p < 0.01) and longer index admission (10 vs. 9 days, p < 0.01). Age and insurance status had no significant association with readmission. Multivariate analysis demonstrated that higher severity of illness (odds ratio [OR] 1.36, 95 % confidence interval [CI] 1.04–1.77, p = 0.02), discharge to rehab (OR 1.41, 95 % CI 1.19–1.66, p < 0.001), and surgery at the lowest volume hospitals (OR 1.28, 95 % CI 1.08–1.51, p = 0.004) were factors independently associated with readmission.

Conclusions

Lower hospital volume is a significant risk factor for readmission after PD. To minimize the excess resource utilization that accompanies readmission, patients undergoing complex oncologic pancreatic surgery should be directed to hospitals most experienced in caring for this patient population.
Literature
1.
2.
Rosemurgy AS, Luberice K, Paul H, Co F, Vice M, Toomey P, et al. Readmissions after pancreaticoduodenectomy: efforts need to focus on patient expectations and nonhospital medical care. Am Surg. 2012;78(8):837–43.PubMed
3.
Ahmad SA, Edwards MJ, Sutton JM, Grewal SS, Hanseman DJ, Maithel SK, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012;256(3):529–37.CrossRefPubMed
4.
Emick DM, Riall TS, Cameron JL, Winter JM, Lillemoe KD, Coleman J, et al. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg. 2006;10(9):1243–52; discussion 52–3.CrossRefPubMed
5.
van Geenen RC, van Gulik TM, Busch OR, de Wit LT, Obertop H, Gouma DJ. Readmissions after pancreatoduodenectomy. Br J Surg. 2001;88(11):1467–71.CrossRefPubMed
6.
Fong ZV, Ferrone CR, Thayer SP, Wargo JA, Sahora K, Seefeld KJ, et al. Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them?: a 10-year contemporary experience with 1,173 patients at the Massachusetts General Hospital. J Gastrointest Surg. 2014;18(1):137–44.CrossRefPubMed
7.
Fernandez-del Castillo C, Morales-Oyarvide V, McGrath D, Wargo JA, Ferrone CR, Thayer SP, et al. Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S56–63.CrossRef
8.
Grewal SS, McClaine RJ, Schmulewitz N, Alzahrani MA, Hanseman DJ, Sussman JJ, et al. Factors associated with recidivism following pancreaticoduodenectomy. HPB (Oxford). 2011;13(12):869–75.PubMedCentralCrossRefPubMed
9.
Coates JM, Beal SH, Russo JE, Vanderveen KA, Chen SL, Bold RJ, et al. Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy. Arch Surg. 2009;144(9):841–7.CrossRefPubMed
10.
Langan RC, Graham JA, Chin AB, Rubinstein AJ, Oza K, Nusbaum JA, et al. Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery. 2014;156(2):379–84.CrossRefPubMed
11.
Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. 2011;25(7):2084–99.CrossRefPubMed
12.
Bao PQ, Mazirka PO, Watkins KT. Retrospective Comparison of Robot-Assisted Minimally Invasive Versus Open Pancreaticoduodenectomy for Periampullary Neoplasms. J Gastrointest Surg. 2013;18(4);682–9.CrossRef
13.
Reddy DM, Townsend CM, Jr., Kuo YF, Freeman JL, Goodwin JS, Riall TS. Readmission after pancreatectomy for pancreatic cancer in Medicare patients. J Gastrointest Surg. 2009;13(11):1963–74; discussion 74–5.PubMedCentralCrossRefPubMed
14.
Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC, Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012;215(3):322–30.PubMedCentralCrossRefPubMed
15.
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.CrossRefPubMed
16.
Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138(7):721–5; discussion 6.CrossRefPubMed
17.
Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349(22):2117–27.CrossRefPubMed
18.
19.
Sutton JM, Hayes AJ, Wilson GC, Quillin RC 3rd, Wima K, Hohmann S, et al. Validation of the University HealthSystem Consortium administrative dataset: concordance and discordance with patient-level institutional data. J Surg Res. 2014;190(2):484–90.CrossRefPubMed
20.
Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106.CrossRefPubMed
21.
Birkmeyer NJ, Gu N, Baser O, Morris AM, Birkmeyer JD. Socioeconomic status and surgical mortality in the elderly. Med Care. 2008;46(9):893–9.CrossRefPubMed
22.
Kent TS, Sachs TE, Callery MP, Vollmer CM, Jr. Readmission after major pancreatic resection: a necessary evil? J Am Coll Surg. 2011;213(4):515–23.CrossRefPubMed
23.
Gawlas I, Sethi M, Winner M, Epelboym I, Lee JL, Schrope BA, et al. Readmission after pancreatic resection is not an appropriate measure of quality. Ann Surg Oncol. 2013;20(6):1781–7.CrossRefPubMed
24.
Lee MK, Dinorcia J, Reavey PL, Holden MM, Genkinger JM, Lee JA, et al. Pancreaticoduodenectomy can be performed safely in patients aged 80 years and older. J Gastrointest Surg. 2010;14(11):1838–46.CrossRefPubMed
25.
Turley RS, Peterson K, Barbas AS, Ceppa EP, Paulson EK, Blazer DG, 3rd, et al. Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction. Ann Vasc Surg. 2012;26(5):685–92.CrossRefPubMed
26.
Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37(8):1909–18.CrossRefPubMed
27.
Hyder O, Dodson RM, Nathan H, Schneider EB, Weiss MJ, Cameron JL, et al. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surg. 2013;148(12):1095–102.PubMedCentralCrossRefPubMed
28.
Rosemurgy AS, Bloomston M, Serafini FM, Coon B, Murr MM, Carey LC. Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg. 2001;5(1):21–6.CrossRefPubMed
29.
Hari M, Rosenzweig M. Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: implications for patient education. Oncol Nurs Forum. 2012;39(4):408–12.CrossRefPubMed
30.
Sanford DE, Olsen MA, Bommarito KM, Shah M, Fields RC, Hawkins WG, et al. Association of dishcarge home with home helath care and 30-day readmission after pancreatectomy. J Am Coll Surg. 2014 Nov;219(5):875–86.CrossRefPubMed
31.
32.
Topal B, Peeters G, Vandeweyer H, Aerts R, Penninckx F. Hospital cost-categories of pancreaticoduodenectomy. Acta Chir Belg. 2007;107(4):373–7.PubMed
33.
Yermilov I, Bentrem D, Sekeris E, Jain S, Maggard MA, Ko CY, et al. Readmissions following pancreaticoduodenectomy for pancreas cancer: a population-based appraisal. Ann Surg Oncol. 2009;16(3):554–61.CrossRefPubMed
34.
Zhu ZY, He JK, Wang YF, Liang X, Yu H, Wang XF, et al. Multivariable analysis of factors associated with hospital readmission following pancreaticoduodenectomy for malignant diseases. Chin Med J (Engl). 2011;124(7):1022–5.PubMed
Metadata
Title
Readmission After Pancreaticoduodenectomy: The Influence of the Volume Effect Beyond Mortality
Authors
Jeffrey M. Sutton, MD
Gregory C. Wilson, MD
Koffi Wima, MS
Richard S. Hoehn, MD
R. Cutler Quillin III, MD
Dennis J. Hanseman, PhD
Ian M. Paquette, MD
Jeffrey J. Sussman, MD
Syed A. Ahmad, MD
Shimul A. Shah, MD, MCHM
Daniel E. Abbott, MD
Publication date
01-11-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 12/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4451-1

Other articles of this Issue 12/2015

Annals of Surgical Oncology 12/2015 Go to the issue

Endocrine Tumors

Wide Inter-institutional Variation in Performance of a Molecular Classifier for Indeterminate Thyroid Nodules

Breast Oncology

Survival is Better After Breast Conserving Therapy than Mastectomy for Early Stage Breast Cancer: A Registry-Based Follow-up Study of Norwegian Women Primary Operated Between 1998 and 2008

Breast Oncology

The Role of Sentinel Lymph Node Biopsy and Factors Associated with Invasion in Extensive DCIS of the Breast Treated by Mastectomy: The Cinnamome Prospective Multicenter Study

Breast Oncology

Characterizing Breast Cancer in a Population with Increased Prevalence of Triple-Negative Breast Cancer: Androgen Receptor and ALDH1 Expression in Ghanaian Women

Gynecologic Oncology

Feasibility and Safety of Negative-Balance Isolated Pelvic Perfusion in Patients with Pretreated Recurrent or Persistent Uterine Cervical Cancer

Thoracic Oncology

Recurrence Risk-Scoring Model for Stage I Adenocarcinoma of the Lung