Index versus Non-index Readmission After Hepato-Pancreato-Biliary Surgery: Where Do Patients Go to Be Readmitted?

• Published in: Journal of gastrointestinal surgery 2019-04, Vol.23 (4), p.702-711
• Main Authors: Beal, Eliza W., Bagante, Fabio, Paredes, Anghela, Chen, Qinyu, Akgul, Ozgur, Merath, Katiuscha, Dillhoff, Mary E., Cloyd, Jordan M., Pawlik, Timothy M.
• Format: Article
• Language: English
• Subjects: 2018 SSAT Quick Shot Presentation; Adolescent; Adult; Aged; Aged, 80 and over; Biliary Tract Surgical Procedures; Continuity of Patient Care - standards; Continuity of Patient Care - statistics & numerical data; Databases, Factual; Female; Gastroenterology; Gastrointestinal surgery; Hepatectomy; Hospital Mortality; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Pancreatectomy; Patient admissions; Patient Readmission - standards; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Quality Indicators, Health Care - statistics & numerical data; Retrospective Studies; Surgery; United States; Young Adult
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3882-y

Introduction The Center for Medicare and Medicaid Services (CMS) has identified readmission as an important quality metric. With an increased emphasis on regionalization of complex hepato-pancreato-biliary (HPB) surgery to high-volume centers, care of readmitted HPB patients may be fragmented if readmission occurs at a non-index hospital. We sought to define the proportion of HPB readmissions, as well as evaluate outcomes, that occur at an index versus non-index hospitals and to identify factors associated with non-index hospital readmission. Methods The National Readmissions Database (NRD) was used to identify patients who underwent major HPB surgery between 2010 and 2015. Factors associated with readmission at 30 and 90 days at index versus non-index hospitals were analyzed. Differences in mortality and complications were analyzed among patients readmitted to index versus non-index hospitals. Results A total of 49,080 patients underwent HPB surgery (liver n  = 27,081, 55%; pancreas n  = 14,787, 30%; biliary n  = 7212, 15%). Overall, 6643 (14%) and 11,709 (24%) patients were readmitted within 30 and 90 days, respectively. Among all first readmissions, 18 and 21% were to a non-index hospital within the first 30 and 90 days, respectively. On multivariable analysis, factors associated with readmission to a non-index hospital included age (OR 1.19, 95% CI 1.05, 1.34), pancreatic cancer (OR 1.40, 95% CI 1.14, 1.34) and ≥ 3 comorbidities (OR 1.34, 95% CI 1.10, 1.63), while procedures on the pancreas (OR 0.69, 95% CI 0.61, 0.80), private insurance (OR 0.77, 95% CI 0.68, 0.87), initial admission at a large hospital (OR 0.77, 95% CI 0.65, 0.91), and initial admission length of stay > 7 days (OR 0.77, 95% CI 0.69, 0.86) were associated with decreased odds of a non-index hospital readmission (all p