Maria S Altieri1, Jie Yang2, Donglei Yin3, Konstantinos Spaniolas4, Mark Talamini4, Aurora Pryor4. 1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, 11794, NY, USA. altieri.m@gmail.com. 2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA. 3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA. 4. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, 11794, NY, USA.
Abstract
INTRODUCTION: Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2 years) following Hepatopancreatobiliary (HPB) surgery in the state of New York. METHODS: The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2 years following surgery to identify all-cause readmissions. Factors for readmissions included patient demographics, comorbidities, perioperative complications, surgery type, and academic status. Multivariable generalized linear mixed models were performed to evaluate risk factors for readmissions. RESULTS: There were 6207 complex HPB procedures with 1272 (20.49%) unplanned 30-day readmissions, 816 (13.15%) unplanned 31-90-day readmissions, 1678 (27.03%) unplanned 91-day to 1-year readmissions, and 1404 (22.62%) 1-2-year readmissions. After adjusting for other possible confounding factors, risk factors for 30-day readmissions include surgery type, as pancreatectomy and gallbladder patients are more likely to have a 30-day readmission than hepatectomy patients, facility type, as academic centers are more likely to have a readmission, male gender, presence of any comorbidity, and peri-operative complications. Risk factors for 31-90-day readmissions include race, insurance group, any comorbidity or any peri-operative complication, and 30-day readmissions. Risk factors for 91-day to 1-year readmissions include male gender, race, any comorbidity, 30-day readmissions, and 31-90 days' readmissions. Risk factors for 1-2-year readmissions include presence of any comorbidity, and previous 91-day to 1-year readmissions. CONCLUSION: The 30-day readmission window is an inadequate, but predictive, measure of total readmission following complex HPB procedures.
INTRODUCTION: Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2 years) following Hepatopancreatobiliary (HPB) surgery in the state of New York. METHODS: The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2 years following surgery to identify all-cause readmissions. Factors for readmissions included patient demographics, comorbidities, perioperative complications, surgery type, and academic status. Multivariable generalized linear mixed models were performed to evaluate risk factors for readmissions. RESULTS: There were 6207 complex HPB procedures with 1272 (20.49%) unplanned 30-day readmissions, 816 (13.15%) unplanned 31-90-day readmissions, 1678 (27.03%) unplanned 91-day to 1-year readmissions, and 1404 (22.62%) 1-2-year readmissions. After adjusting for other possible confounding factors, risk factors for 30-day readmissions include surgery type, as pancreatectomy and gallbladder patients are more likely to have a 30-day readmission than hepatectomy patients, facility type, as academic centers are more likely to have a readmission, male gender, presence of any comorbidity, and peri-operative complications. Risk factors for 31-90-day readmissions include race, insurance group, any comorbidity or any peri-operative complication, and 30-day readmissions. Risk factors for 91-day to 1-year readmissions include male gender, race, any comorbidity, 30-day readmissions, and 31-90 days' readmissions. Risk factors for 1-2-year readmissions include presence of any comorbidity, and previous 91-day to 1-year readmissions. CONCLUSION: The 30-day readmission window is an inadequate, but predictive, measure of total readmission following complex HPB procedures.
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