Aguayo Esteban, Antonios James, Sanaiha Yas, Dobaria Vishal, Sareh Sohail, Huynh Ashley, Benharash Peyman, King Jonathan C
Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California.
Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Department of Surgery, University of California Los Angeles, Los Angeles, California.
J Surg Res. 2020 Nov;255:304-310. doi: 10.1016/j.jss.2020.04.037. Epub 2020 Jun 24.
Pancreatectomy is a complex operation that has been associated with excess morbidity and mortality. Although acute index outcomes have been characterized, there are limited data available on nonelective readmission after pancreatic surgery. We sought to identify factors associated with 30-day and 30- to 90-day readmission after pancreatectomy.
We utilized the National Readmissions Database between 2010 and 2016 to identify adults who underwent a pancreatectomy. The primary outcomes were 30-day (30DR) and 30- to 90-day (90DR) readmission. Secondary outcomes included nonelective readmission trends, diagnosis, length of stay, charges, and mortality.
Of an estimated 130,267 subjects undergoing pancreatectomy, 97% survived index hospitalization. Eighteen percent of patients had nonelective 30DR while 5.6% experienced 90DR. Readmission at the two time points remained stable during the study period. After adjusting for institution, pancreatectomy volume, mortality (2.0% versus 4.9%, P < 0.001), 30DR length of stay (7.3 d versus 7.8 d, P < 0.001), and 90DR rates (6.9% versus 8.1%, P = 0.003) were significantly decreased at high-volume pancreatectomy centers compared to low-volume hospitals. Discharge to a skilled nursing facility (AOR: 1.52) or with home health care (AOR: 1.2) was associated with 30DR (P < 0.001). Patients undergoing total pancreatectomy (AOR: 1.3) or those with a substance use disorder (AOR: 1.4) among others were associated with 90DR (P ≤ 0.01).
Readmissions are common and costly after pancreatectomy. Approximately 20% of patients experience readmission within 30 d. 30DR and 90DR rates remained stable during the study. Pancreatectomy at a high-volume center was associated with decreased mortality and 90DR. The present analysis confirms associations between pancreatectomy volume, postsurgical complications, comorbidities, and readmission.
胰腺切除术是一项复杂的手术，与较高的发病率和死亡率相关。尽管已经描述了急性指标结局，但关于胰腺手术后非选择性再入院的数据有限。我们试图确定与胰腺切除术后30天和30至90天再入院相关的因素。
我们利用2010年至2016年的国家再入院数据库来识别接受胰腺切除术的成年人。主要结局是30天（30DR）和30至90天（90DR）再入院。次要结局包括非选择性再入院趋势、诊断、住院时间、费用和死亡率。
在估计的130267名接受胰腺切除术的受试者中，97%在首次住院期间存活。18%的患者有非选择性30DR，而5.6%经历了90DR。在研究期间，两个时间点的再入院率保持稳定。在调整了机构、胰腺切除量、死亡率（2.0%对4.9%，P<0.001）、30DR住院时间（7.3天对7.8天，P<0.001）和90DR率（6.9%对8.1%，P=0.003）后，与低容量医院相比，高容量胰腺切除中心的30DR和90DR率显著降低。出院至熟练护理机构（调整后比值比：1.52）或接受家庭医疗护理（调整后比值比：1.2）与30DR相关（P<0.001）。接受全胰腺切除术的患者（调整后比值比：1.3）或患有物质使用障碍的患者（调整后比值比：1.4）等与90DR相关（P≤0.01）。
胰腺切除术后再入院很常见且成本高昂。约20%的患者在30天内经历再入院。在研究期间，30DR和90DR率保持稳定。在高容量中心进行胰腺切除术与死亡率降低和90DR相关。本分析证实了胰腺切除量、术后并发症、合并症和再入院之间的关联。
