Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: implications for patient education.

PURPOSE/OBJECTIVES: To determine readmission rates post-pancreaticoduodenectomy (PD), readmission reasons following PD, and patients' postoperative education prior to discharge.

DESIGN

Retrospective, descriptive study of established medical records of patients who have undergone PD from 2006-2008.

SETTING

PD cohort from a pancreatic cancer program.

SAMPLE

62 patients aged 18 years or older, diagnosed with pancreatic cancer, who had PD.

METHODS

Data abstracted from inpatient and outpatient electronic records as per study protocol and entered into Excel® spreadsheet for analysis.

MAIN RESEARCH VARIABLES

Incidences of and reasons for readmissions post the PD procedure. Discharge education given to patients prior to discharge.

FINDINGS

Patients were discharged at mean postoperative day 11.3. Readmission rate was 28%. Reasons for readmission were dehydration or malnutrition (n = 10, 16%) and surgical site infection (n = 7, 11%); 10% of patients (n = 6) had documented difficulties with dehydration, malnutrition, and failure to thrive noted at follow-up. PD discharge teaching was documented in a mandatory discharge form. No standard curriculum was used.

CONCLUSIONS

Patients undergoing PD experience an increase in self-care demand postdischarge. Poor discharge education can lead to high rates of readmission, specifically for dehydration and malnutrition, mandating an assessment of patient education prior to discharge.

IMPLICATIONS FOR NURSING

Close attention must be given to the needs of patients with pancreatic cancer postdischarge. Trying to identify the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications. Educational focus for patients undergoing PD should be on prevention of dehydration, malnutrition, and surgical site infections.