Tosoian Jeffrey J, Hicks Caitlin W, Cameron John L, Valero Vicente, Eckhauser Frederic E, Hirose Kenzo, Makary Martin A, Pawlik Timothy M, Ahuja Nita, Weiss Matthew J, Wolfgang Christopher L
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Surg. 2015 Feb;150(2):152-8. doi: 10.1001/jamasurg.2014.2346.
Readmission after pancreatectomy is common, but few data compare patterns of readmission to index and nonindex hospitals.
To evaluate the rate of readmission to index and nonindex institutions following pancreatectomy at a tertiary high-volume institution and to identify patient-level factors predictive of those readmissions.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of a prospectively collected institutional database linked to statewide data of patients who underwent pancreatectomy at a tertiary care referral center between January 1, 2005, and December 2, 2010.
Pancreatectomy.
The primary outcome was unplanned 30-day readmission to index or nonindex hospitals. Risk factors and reasons for readmission were measured and compared by site using univariable and multivariable analyses.
Among all 623 patients who underwent pancreatectomy during the study period, 134 (21.5%) were readmitted to our institution (105 [78.4%]) or to an outside institution (29 [21.6%]). Fifty-six patients (41.8%) were readmitted because of a gastrointestinal or nutritional problem related to surgery and 42 patients (31.3%) because of a postoperative infection. On multivariable analysis, factors independently associated with readmission included age 65 years or older (odds ratio [OR], 1.80; 95% CI, 1.19-2.71), preexisting liver disease (OR, 2.28; 95% CI, 1.23-4.24), distal pancreatectomy (OR, 1.77; 95% CI, 1.11-2.84), and postoperative drain placement (OR, 2.81; 95% CI, 1.00-7.14).
In total, 21.5% of patients required early readmission after pancreatectomy. Even in the setting of a tertiary care referral center, 21.6% of these readmissions were to nonindex institutions. Specific patient-level factors were associated with an increased risk of readmission.
胰腺切除术后再入院情况很常见，但很少有数据比较再入院至初次手术医院和非初次手术医院的模式。
评估在一家高容量的三级医疗机构中，胰腺切除术后患者再入院至初次手术机构和非初次手术机构的比例，并确定预测这些再入院情况的患者层面因素。
设计、地点和参与者：对一个前瞻性收集的机构数据库进行回顾性分析，该数据库与2005年1月1日至2010年12月2日期间在一家三级医疗转诊中心接受胰腺切除术的患者的全州数据相关联。
胰腺切除术。
主要结局是计划外30天再入院至初次手术或非初次手术医院。通过单变量和多变量分析，按地点测量并比较再入院的危险因素和原因。
在研究期间接受胰腺切除术的所有623例患者中，134例（21.5%）再入院至我们的机构（105例[78.4%]）或外部机构（29例[21.6%]）。56例患者（41.8%）因与手术相关的胃肠道或营养问题再入院，42例患者（31.3%）因术后感染再入院。多变量分析显示，与再入院独立相关的因素包括65岁及以上年龄（比值比[OR]，1.80；95%置信区间[CI]，1.19 - 2.71）、既往有肝病（OR，2.28；95% CI，1.23 - 4.24）、胰体尾切除术（OR，1.77；95% CI，1.11 - 2.84）以及术后放置引流管（OR，2.81；95% CI，1.00 - 7.14）。
总体而言，21.5%的患者在胰腺切除术后需要早期再入院。即使在三级医疗转诊中心的环境下，这些再入院患者中有21.6%是进入非初次手术机构。特定的患者层面因素与再入院风险增加相关。
