David A Mahvi1, Linda M Pak2, Richard D Urman3, Jason S Gold4, Edward E Whang5. 1. Department of Surgery, Brigham and Women's Hospital/ Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: dmahvi@partners.org. 2. Department of Surgery, Brigham and Women's Hospital/ Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: lpak@bwh.harvard.edu. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA. Electronic address: rurman@bwh.harvard.edu. 4. Department of Surgery, Brigham and Women's Hospital/ Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA; Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA. Electronic address: jgold@bwh.harvard.edu. 5. Department of Surgery, Brigham and Women's Hospital/ Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA; Department of Surgery, VA Boston Healthcare System, West Roxbury, MA, USA. Electronic address: ewhang1@bwh.harvard.edu.
Abstract
INTRODUCTION: Pancreaticoduodenectomy is a complex surgical procedure. The purpose of this study was to identify factors associated non-home discharge destination and to characterize outcomes after non-home discharge. METHODS: 10,719 pancreaticoduodenectomy cases contained in the National Surgical Quality Improvement Program (NSQIP) Targeted Pancreatectomy dataset (years 2014-2016) were examined with univariate and multivariate logistic regression. RESULTS: 1336 patients (12.5%) were discharged to rehabilitation, skilled care, or acute care facilities. Preoperative factors significantly associated with non-home discharge on multivariate analysis were female gender, older age, elevated BMI, poor functional status or dyspnea, smoking, low albumin, COPD, and ascites. Intraoperative factors significantly associated with non-home discharge destination on multivariate analysis were longer operative time, open surgery, softer pancreatic texture, drain placement, and jejunostomy tube placement. A nomogram was generated for estimating probability of non-home discharge immediately after surgery. CONCLUSION: Preoperative and intraoperative factors can be used to predict probability of non-home discharge immediately after completion of pancreaticoduodenectomy.
INTRODUCTION: Pancreaticoduodenectomy is a complex surgical procedure. The purpose of this study was to identify factors associated non-home discharge destination and to characterize outcomes after non-home discharge. METHODS: 10,719 pancreaticoduodenectomy cases contained in the National Surgical Quality Improvement Program (NSQIP) Targeted Pancreatectomy dataset (years 2014-2016) were examined with univariate and multivariate logistic regression. RESULTS: 1336 patients (12.5%) were discharged to rehabilitation, skilled care, or acute care facilities. Preoperative factors significantly associated with non-home discharge on multivariate analysis were female gender, older age, elevated BMI, poor functional status or dyspnea, smoking, low albumin, COPD, and ascites. Intraoperative factors significantly associated with non-home discharge destination on multivariate analysis were longer operative time, open surgery, softer pancreatic texture, drain placement, and jejunostomy tube placement. A nomogram was generated for estimating probability of non-home discharge immediately after surgery. CONCLUSION: Preoperative and intraoperative factors can be used to predict probability of non-home discharge immediately after completion of pancreaticoduodenectomy.
Authors: Anne M Suskind; Shoujun Zhao; W John Boscardin; Alexander Smith; Emily Finlayson Journal: J Am Geriatr Soc Date: 2020-01-25 Impact factor: 5.562
Authors: Katelyn F Flick; C Max Schmidt; Cameron L Colgate; Michele T Yip-Schneider; Chris M Sublette; Thomas K Maatman; Mazhar Soufi; Eugene P Ceppa; Michael G House; Nicholas J Zyromski; Attila Nakeeb Journal: J Gastrointest Surg Date: 2020-06-24 Impact factor: 3.452
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