Rauf Shahbazov1, Bashoo Naziruddin2, Kunal Yadav3, Giovanna Saracino4, Gumpei Yoshimatsu5, Mazhar A Kanak3, Ernest Beecherl4, Peter T Kim4, Marlon F Levy3. 1. Department of Surgery, University of Virginia, Charlottesville, VA, USA. 2. Baylor Annette C. and Harold C. Simmons Transplant Institute, Dallas-Fort Worth, TX, USA. Electronic address: bashoo.naziruddin@bswhealth.org. 3. Division of Transplantation, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA. 4. Baylor Annette C. and Harold C. Simmons Transplant Institute, Dallas-Fort Worth, TX, USA. 5. Islet Cell Laboratory, Baylor Research Institute, Dallas, TX, USA.
Abstract
BACKGROUND: Little published data exist examining causes of hospital readmission following total pancreatectomy with islet autotransplantation (TPIAT). METHODS: A retrospective analysis was performed of a prospectively collected institutional TPIAT database. Primary outcome was unplanned readmission to the hospital within 30 days from discharge. Reasons and risk factors for readmission as well as islet function were evaluated and compared by univariate and multivariate analysis. RESULTS: 83 patients underwent TPIAT from 2006 to 2014. 21 patients (25.3%) were readmitted within 30 days. Gastrointestinal problems (52.4%) and surgical site infection (42.8%) were the most common reasons for readmission. Initial LOS and reoperation were risk factors for early readmission. Patients with delayed gastric emptying (DGE) were three times more likely to get readmitted. In multivariate analysis, patients undergoing pylorus preservation surgery were nine times more likely to be readmitted than the antrectomy group. CONCLUSION: Early readmission after TPIAT is common (one in four patients), underscoring the complexity of this procedure. Early readmission is not detrimental to islet graft function. Patients undergoing pylorus preservation are more likely to get readmitted, perhaps due to increased incidence of delayed gastric emptying. Decision for antrectomy vs. pylorus preservation needs to be individualized.
BACKGROUND: Little published data exist examining causes of hospital readmission following total pancreatectomy with islet autotransplantation (TPIAT). METHODS: A retrospective analysis was performed of a prospectively collected institutional TPIAT database. Primary outcome was unplanned readmission to the hospital within 30 days from discharge. Reasons and risk factors for readmission as well as islet function were evaluated and compared by univariate and multivariate analysis. RESULTS: 83 patients underwent TPIAT from 2006 to 2014. 21 patients (25.3%) were readmitted within 30 days. Gastrointestinal problems (52.4%) and surgical site infection (42.8%) were the most common reasons for readmission. Initial LOS and reoperation were risk factors for early readmission. Patients with delayed gastric emptying (DGE) were three times more likely to get readmitted. In multivariate analysis, patients undergoing pylorus preservation surgery were nine times more likely to be readmitted than the antrectomy group. CONCLUSION: Early readmission after TPIAT is common (one in four patients), underscoring the complexity of this procedure. Early readmission is not detrimental to islet graft function. Patients undergoing pylorus preservation are more likely to get readmitted, perhaps due to increased incidence of delayed gastric emptying. Decision for antrectomy vs. pylorus preservation needs to be individualized.
Authors: Jaimie D Nathan; Yi Yang; Anne Eaton; Piotr Witkowski; Martin Wijkstrom; Matthew Walsh; Guru Trikudanathan; Vikesh K Singh; Sarah J Schwarzenberg; Timothy L Pruett; Andrew Posselt; Bashoo Naziruddin; Sri Prakash Mokshagundam; Katherine Morgan; Luis F Lara; Varvara Kirchner; Jin He; Timothy B Gardner; Martin L Freeman; Kate Ellery; Darwin L Conwell; Srinath Chinnakotla; Gregory J Beilman; Syed Ahmad; Maisam Abu-El-Haija; James S Hodges; Melena D Bellin Journal: Pancreatology Date: 2021-09-29 Impact factor: 3.996