Thirty days are inadequate for assessing readmission following complex hepatopancreatobiliary procedures

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.

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