Objective: Patients undergoing pancreaticoduodenectomy (PD) frequently require post-hospital recovery at rehabilitation facilities. Early identification of patients at risk for rehab placement may help with pre-operative education, risk stratification, and discharge planning. We evaluated the predictive role of early perioperative factors on rehabilitation facility placement to identify patients who may require this service. Methods: The ACS-NSQIP pancreas-targeted database was queried to identify patients who underwent pancreaticoduodenectomy (PD) in 2014. Patients who originated from a facility, those with unknown or expired discharge disposition, and emergency cases were excluded. All perioperative variables were assessed via multivariate logistic regression analysis to identify predictors of discharge to a rehabilitation facility. Results: Of 3073 PD patients with complete data, 409 (13.3%) were discharged to rehab. Mean age was 64, 53.7% were male. Most PDs (80%, n=2458) were performed for malignant disease. Vascular resection was performed in 16.4% of cases, while 7.1% underwent an additional major concurrent procedure, the most common of which were ventral hernia repair, partial colectomy, component separation, hepatic resection, and partial/total nephrectomy. On multivariate analysis, age, ASA score, BMI, dyspnea, COPD, ascites, chronic dialysis, non-malignant indication, and major concurrent procedure were predictive of rehab disposition. Neoadjuvant therapy and vascular resection were not significant, even on subgroup analysis of exclusively malignant cases. Conclusion: Perioperative risk factors that predict need for post-operative rehabilitation after PD include advancing age, BMI, ASA score, presence of major comorbidities, and undergoing a major concurrent procedure. At-risk patients may benefit from additional preoperative education/risk stratification, and earlier engagement of advanced discharge planning services.Table 1Multivariate model for predictors of rehabilitation placement amongst patients undergoing pancreaticoduodenectomy.VariableOdds ratio95% Confidence intervalP valueAge1.0941.0771.110.000Female1.214.9471.557.126ASA ≥ 31.5081.0462.172.028BMI1.0361.0141.059.001Diabetes1.222.9771.409.073Dyspnea1.6221.0112.603.045Non-Caucasian0.854.5671.287.451Active smoker1.293.9991.500.051COPD2.0931.3143.331.002Ascites11.0722.34752.244.002CHF2.576.29522.495.392Hypertension1.185.9251.382.148Acute renal failure1.167.08715.686.908Dialysis36.6661.938693.878.016Open wound/infection present at time of surgery1.190.1449.810.872Chronic steroids1.352.7341.678.204Preop sepsis.897.2722.958.859Transfusion with 72 hrs1.440.2921.816.308Weight loss >10%1.137.8231.367.353Bleeding disorder1.351.5341.391.649Wound classification ≥31.251.9601.461.085Obstructive jaundice.825.6051.126.226Preoperative biliary stent0.933.6861.273.663Minimally-invasive approach0.548.2901.033.063Vascular resection0.984.7021.379.925Major concurrent procedure2.2451.4683.435.000Malignant indication0.504.350.728.000Pancreatitis histology0.546.301.990.046Age, ASA score, BMI, dyspnea, COPD, ascites, chronic dialysis, and undergoing major concurrent procedure were predictive of rehabilitation placement. Malignant (compared to benign) indication and pancreatitis present on histology were protective against rehab placement. Open table in a new tab Age, ASA score, BMI, dyspnea, COPD, ascites, chronic dialysis, and undergoing major concurrent procedure were predictive of rehabilitation placement. Malignant (compared to benign) indication and pancreatitis present on histology were protective against rehab placement.