The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study.

Hao-Wei Kou,Yi-Fu Chen,Ta-Sen Yeh,Chao-Wei Lee,Chih-Po Hsu,Jun-Te Hsu,Shang-Yu Wang,Tsann-Long Hwang,Jen-Fu Huang,Chun-Nan Yeh,Shih-Chun Chang

doi:10.3390/healthcare10010126

Hao-Wei Kou, Yi-Fu Chen + Show 9 more

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https://doi.org/10.3390/healthcare10010126

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Abstract

Background: Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. Methods: We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. Results: The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. Conclusions: UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.

Highlights

Pancreaticoduodenectomy (PD) is surgery for both benign and malignant diseases affecting the periampullary area
Our present findings suggest that the severity of Postoperative pancreatic fistula (POPF) and the presence of postoperative biliary drainage were independently associated with unplanned hospital visits and readmissions 30 days after discharge, providing valuable information for physicians, policy-makers, administrators, and medical insurers to adopt preventive strategies to improve the quality of healthcare
Our present results showed that POPF was an independent predictor of hospital readmission and of unplanned hospital visits

Summary

Introduction

Pancreaticoduodenectomy (PD) is surgery for both benign and malignant diseases affecting the periampullary area. Various risk factors have been proven to be associated with readmission after PD, and the presence of postoperative pancreatic fistula (POPF) is one of them. Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients’ postoperative recovery and are associated with increased financial burden and morbidity. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality

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