Patient readmission and mortality after surgery for hepato-pancreato- biliary malignancies

Eric B. Schneider, Omar Hyder, Christopher L. Wolfgang, Kenzo Hirose, Michael A. Choti, Martin A. Makary, Joseph M. Herman, John L. Cameron, Timothy M. Pawlik

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Abstract

Background: The incidence and associated risk factors for readmission after hepato-pancreato-biliary surgery are poorly characterized. The objective of the current study was to compare readmission after pancreatic vs hepatobiliary surgical procedures, as well as to identify potential factors associated with higher readmission within 30 days of discharge. Study Design: Using Surveillance, Epidemiology and End Results-Medicare linked data from 1986-2005, we identified 9,957 individuals aged 66 years and older who underwent complex hepatic, biliary, or pancreatic procedures for cancer treatment and were eligible for analysis. In-hospital morbidity, mortality, and 30-day readmission were examined. Results: Primary surgical treatment consisted of a pancreatic (46.7%), hepatic (50.0%), or biliary (3.4%) procedure. Mean patient age was 72.6 years and most patients were male (53.2%). The number of patients with multiple preoperative comorbidities increased over time (patients with Elixhauser's comorbidity score >13: 1986-1990, 47.0% vs 2001-2005, 62.9%; p < 0.001). Pancreatic operations had higher inpatient mortality vs hepatobiliary procedures (9.2% vs 7.3%; p < 0.001). Mean length of stay after pancreatic procedures was longer compared with hepatobiliary procedures (19.7 vs 10.3 days; p < 0.001). The proportion of patients readmitted after a pancreatic (1986-1990, 17.7%; 1991-1995, 16.1%; 1996-2000, 18.6%; 2001-2005, 19.6%; p = 0.15) or hepatobiliary (1986-1990, 14.3%; 1991-1995, 14.1%; 1996-2000, 15.2%; 2001-2005, 15.5%; p = 0.69) procedure did not change over time. Factors associated with increased risk of readmission included preoperative Elixhauser comorbidities >13 (odds ratio = 1.90) and prolonged index hospital stay <10 days (odds ratio = 1.54; both p < 0.05). During the readmission, additional morbidity and mortality were 46.5% and 8.0%, respectively. Conclusions: Although the incidence of readmission did not change across the time periods examined, readmission was higher among patients undergoing a pancreatic procedure vs a hepatobiliary procedure. Other factors associated with risk of readmission included number of patient comorbidities and prolonged hospital stay. Readmission was associated with additional short-term morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)607-615
Number of pages9
JournalJournal of the American College of Surgeons
Volume215
Issue number5
DOIs
StatePublished - Nov 2012

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Patient Readmission
Mortality
Comorbidity
Neoplasms
Morbidity
Length of Stay
Odds Ratio
Liver
Incidence
Medicare
Hospital Mortality
Pancreatic Neoplasms
Epidemiology
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Schneider, E. B., Hyder, O., Wolfgang, C. L., Hirose, K., Choti, M. A., Makary, M. A., ... Pawlik, T. M. (2012). Patient readmission and mortality after surgery for hepato-pancreato- biliary malignancies. Journal of the American College of Surgeons, 215(5), 607-615. https://doi.org/10.1016/j.jamcollsurg.2012.07.007

Patient readmission and mortality after surgery for hepato-pancreato- biliary malignancies. / Schneider, Eric B.; Hyder, Omar; Wolfgang, Christopher L.; Hirose, Kenzo; Choti, Michael A.; Makary, Martin A.; Herman, Joseph M.; Cameron, John L.; Pawlik, Timothy M.

In: Journal of the American College of Surgeons, Vol. 215, No. 5, 11.2012, p. 607-615.

Research output: Contribution to journalArticle

Schneider, EB, Hyder, O, Wolfgang, CL, Hirose, K, Choti, MA, Makary, MA, Herman, JM, Cameron, JL & Pawlik, TM 2012, 'Patient readmission and mortality after surgery for hepato-pancreato- biliary malignancies', Journal of the American College of Surgeons, vol. 215, no. 5, pp. 607-615. https://doi.org/10.1016/j.jamcollsurg.2012.07.007
Schneider, Eric B. ; Hyder, Omar ; Wolfgang, Christopher L. ; Hirose, Kenzo ; Choti, Michael A. ; Makary, Martin A. ; Herman, Joseph M. ; Cameron, John L. ; Pawlik, Timothy M. / Patient readmission and mortality after surgery for hepato-pancreato- biliary malignancies. In: Journal of the American College of Surgeons. 2012 ; Vol. 215, No. 5. pp. 607-615.
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abstract = "Background: The incidence and associated risk factors for readmission after hepato-pancreato-biliary surgery are poorly characterized. The objective of the current study was to compare readmission after pancreatic vs hepatobiliary surgical procedures, as well as to identify potential factors associated with higher readmission within 30 days of discharge. Study Design: Using Surveillance, Epidemiology and End Results-Medicare linked data from 1986-2005, we identified 9,957 individuals aged 66 years and older who underwent complex hepatic, biliary, or pancreatic procedures for cancer treatment and were eligible for analysis. In-hospital morbidity, mortality, and 30-day readmission were examined. Results: Primary surgical treatment consisted of a pancreatic (46.7{\%}), hepatic (50.0{\%}), or biliary (3.4{\%}) procedure. Mean patient age was 72.6 years and most patients were male (53.2{\%}). The number of patients with multiple preoperative comorbidities increased over time (patients with Elixhauser's comorbidity score >13: 1986-1990, 47.0{\%} vs 2001-2005, 62.9{\%}; p < 0.001). Pancreatic operations had higher inpatient mortality vs hepatobiliary procedures (9.2{\%} vs 7.3{\%}; p < 0.001). Mean length of stay after pancreatic procedures was longer compared with hepatobiliary procedures (19.7 vs 10.3 days; p < 0.001). The proportion of patients readmitted after a pancreatic (1986-1990, 17.7{\%}; 1991-1995, 16.1{\%}; 1996-2000, 18.6{\%}; 2001-2005, 19.6{\%}; p = 0.15) or hepatobiliary (1986-1990, 14.3{\%}; 1991-1995, 14.1{\%}; 1996-2000, 15.2{\%}; 2001-2005, 15.5{\%}; p = 0.69) procedure did not change over time. Factors associated with increased risk of readmission included preoperative Elixhauser comorbidities >13 (odds ratio = 1.90) and prolonged index hospital stay <10 days (odds ratio = 1.54; both p < 0.05). During the readmission, additional morbidity and mortality were 46.5{\%} and 8.0{\%}, respectively. Conclusions: Although the incidence of readmission did not change across the time periods examined, readmission was higher among patients undergoing a pancreatic procedure vs a hepatobiliary procedure. Other factors associated with risk of readmission included number of patient comorbidities and prolonged hospital stay. Readmission was associated with additional short-term morbidity and mortality.",
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AU - Schneider, Eric B.

AU - Hyder, Omar

AU - Wolfgang, Christopher L.

AU - Hirose, Kenzo

AU - Choti, Michael A.

AU - Makary, Martin A.

AU - Herman, Joseph M.

AU - Cameron, John L.

AU - Pawlik, Timothy M.

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N2 - Background: The incidence and associated risk factors for readmission after hepato-pancreato-biliary surgery are poorly characterized. The objective of the current study was to compare readmission after pancreatic vs hepatobiliary surgical procedures, as well as to identify potential factors associated with higher readmission within 30 days of discharge. Study Design: Using Surveillance, Epidemiology and End Results-Medicare linked data from 1986-2005, we identified 9,957 individuals aged 66 years and older who underwent complex hepatic, biliary, or pancreatic procedures for cancer treatment and were eligible for analysis. In-hospital morbidity, mortality, and 30-day readmission were examined. Results: Primary surgical treatment consisted of a pancreatic (46.7%), hepatic (50.0%), or biliary (3.4%) procedure. Mean patient age was 72.6 years and most patients were male (53.2%). The number of patients with multiple preoperative comorbidities increased over time (patients with Elixhauser's comorbidity score >13: 1986-1990, 47.0% vs 2001-2005, 62.9%; p < 0.001). Pancreatic operations had higher inpatient mortality vs hepatobiliary procedures (9.2% vs 7.3%; p < 0.001). Mean length of stay after pancreatic procedures was longer compared with hepatobiliary procedures (19.7 vs 10.3 days; p < 0.001). The proportion of patients readmitted after a pancreatic (1986-1990, 17.7%; 1991-1995, 16.1%; 1996-2000, 18.6%; 2001-2005, 19.6%; p = 0.15) or hepatobiliary (1986-1990, 14.3%; 1991-1995, 14.1%; 1996-2000, 15.2%; 2001-2005, 15.5%; p = 0.69) procedure did not change over time. Factors associated with increased risk of readmission included preoperative Elixhauser comorbidities >13 (odds ratio = 1.90) and prolonged index hospital stay <10 days (odds ratio = 1.54; both p < 0.05). During the readmission, additional morbidity and mortality were 46.5% and 8.0%, respectively. Conclusions: Although the incidence of readmission did not change across the time periods examined, readmission was higher among patients undergoing a pancreatic procedure vs a hepatobiliary procedure. Other factors associated with risk of readmission included number of patient comorbidities and prolonged hospital stay. Readmission was associated with additional short-term morbidity and mortality.

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