In depth analysis of nationwide readmission rates after hepatobiliary and pancreatic surgery. Does an early discharge equate to a readmission?

Abstract

Presenter: Hassan Aziz MD | University of Southern California Background: The effect of early discharge after hepatobiliary and pancreatic surgery remains controversial. Our objective was to examine the associations between early discharge and readmission after hepatobiliary and pancreatic surgery. Methods: Patients who had liver, bile duct, and pancreatic resections from years 2011-2017 were extracted from ACS NSQIP. Patients discharged prior to the median discharge date for their respective groups were considered early discharges. They were then compared with patients with later discharges in terms of clinical outcomes. Results: A total of 37,831 patients underwent hepatobiliary and pancreatic resections. Individual patient groups and corresponding median day of discharge were: major hepatectomy (n = 9,814; median = 6), distal and total pancreatectomy (n = 33,561; median 4) pancreatoduodenectomy (n = 27,604; median = 8), bile duct resections (5,681; median 4). Early discharge prior to the median discharge was not associated with an increase in the proportion of readmissions in any operative group. Patients discharged later than the median discharge day were more like to have an unplanned readmission 1.65(CI: 1.3-32) unplanned reoperation 3.3(CI: 2.4-4.2) and 30-day mortality 1.2 (CI:1.1-1.6) than their counterparts. Conclusion: Our study does not support the notion that a longer initial hospital length of stay does not lead to a readmission.