Division of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
J Gastrointest Surg. 2021 Jan;25(1):178-185. doi: 10.1007/s11605-020-04714-3. Epub 2020 Jul 15.
Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients.
Hospital cost data from date of discharge to postoperative day 90 were merged with 2008-2018 NSQIP data. Early readmission was within 30 days of surgery, and late readmission was 30 to 90 days from surgery. Regression analyses for readmission controlled for patient comorbidities, complications, and surgeon.
Of 230 patients included, 58 (25%) were readmitted. The mean early and late readmission costs were $18,365 ± $20,262 and $24,965 ± $34,435, respectively. Early readmission was associated with index stay deep vein thrombosis (p < 0.01), delayed gastric emptying (p < 0.01), and grade B pancreatic fistula (p < 0.01). High-cost early readmission had long hospital stays or invasive procedures. Common late readmission diagnoses were grade B pancreatic fistula requiring drainage (n = 5, 14%), failure to thrive (n = 4, 14%), and bowel obstruction requiring operation (n = 3, 11%). High-cost late readmissions were associated with chronic complications requiring reoperation.
Early and late readmissions following pancreaticoduodenectomy differ in both etiology and cost. Early readmission and cost are driven by common complications requiring percutaneous intervention while late readmission and cost are driven by chronic complications and reoperation. Late readmissions are frequent and a significant source of resource utilization. Negotiations of bundled care payment plans should account for significant late readmission resource utilization.
之前关于胰十二指肠切除术患者再入院费用的研究使用了估计成本数据，并未阐明早期和晚期再入院之间的病因或成本差异。我们试图确定胰十二指肠切除术患者术后并发症类型与再入院时间和成本之间的关系。
将出院后至术后第 90 天的住院费用与 2008 年至 2018 年的 NSQIP 数据合并。早期再入院是指手术后 30 天内，晚期再入院是指手术后 30 至 90 天。对再入院进行回归分析时，控制了患者合并症、并发症和外科医生。
在纳入的 230 名患者中，有 58 名（25%）患者再次入院。早期和晚期再入院的平均费用分别为 18365 美元±20262 美元和 24965 美元±34435 美元。早期再入院与索引住院期间深静脉血栓形成（p<0.01）、延迟胃排空（p<0.01）和 B 级胰瘘（p<0.01）有关。高费用的早期再入院有较长的住院时间或侵入性操作。常见的晚期再入院诊断为需要引流的 B 级胰瘘（5 例，14%）、生长不良（4 例，14%）和需要手术的肠梗阻（3 例，11%）。高费用的晚期再入院与需要再次手术的慢性并发症有关。
胰十二指肠切除术后的早期和晚期再入院在病因和成本上存在差异。早期再入院和费用由需要经皮介入的常见并发症驱动，而晚期再入院和费用则由慢性并发症和再次手术驱动。晚期再入院很常见，是资源利用的重要来源。捆绑式护理支付计划的谈判应考虑到晚期再入院资源利用的重要性。
