Background: Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD. Methods: Patients undergoing PD between 2009 and 2016 were reviewed from a prospective database. Predictors of readmission were identified using a multivariable logistic regression model, from which a points-based risk scoring system was derived. Results: 81 of 518 patients (15.6%) were readmitted within 30 days. History of cardiac disease ([odds ratio] OR = 2.12; 95% CI: 1.12–4.56), CRP>140 mg/L on post-operative day 3 (OR = 2.34; 95% CI: 1.37–4.35) and comprehensive complication index >14 (OR = 1.74; 95% CI: 1.03–2.85) were independent predictors of readmission. The regression coefficients were used to generate a risk score with excellent calibration (p = 0.917) and good discrimination (c-index = 0.65; 95% CI: 0.58–0.71; p < 0.001). Patients were categorised as low, moderate and high risk, with readmission rates of 6.4%, 13.4% and 23.0% respectively (p < 0.001). Conclusion: The risk score identifies patients at high risk of readmission after pancreaticoduodenectomy. Such patients may benefit from pre-discharge imaging and/or enhanced follow-up, which may potentially reduce the impact of readmissions.

Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy : development of a validated risk score / A.P.C.S. Boteon, Y.L. Boteon, J. Hodson, H. Osborne, J. Isaac, R. Marudanayagam, D.F. Mirza, P. Muiesan, J.K. Roberts, R.P. Sutcliffe. - In: HPB. - ISSN 1365-182X. - 21:1(2019), pp. 26-33. [10.1016/j.hpb.2018.06.1802]

Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy : development of a validated risk score

P. Muiesan;
2019

Abstract

Background: Unplanned hospital readmission after pancreaticoduodenectomy (PD) is usually due to surgical complications and has significant clinical and economic impact. This study developed a risk score to predict 30-day readmission after PD. Methods: Patients undergoing PD between 2009 and 2016 were reviewed from a prospective database. Predictors of readmission were identified using a multivariable logistic regression model, from which a points-based risk scoring system was derived. Results: 81 of 518 patients (15.6%) were readmitted within 30 days. History of cardiac disease ([odds ratio] OR = 2.12; 95% CI: 1.12–4.56), CRP>140 mg/L on post-operative day 3 (OR = 2.34; 95% CI: 1.37–4.35) and comprehensive complication index >14 (OR = 1.74; 95% CI: 1.03–2.85) were independent predictors of readmission. The regression coefficients were used to generate a risk score with excellent calibration (p = 0.917) and good discrimination (c-index = 0.65; 95% CI: 0.58–0.71; p < 0.001). Patients were categorised as low, moderate and high risk, with readmission rates of 6.4%, 13.4% and 23.0% respectively (p < 0.001). Conclusion: The risk score identifies patients at high risk of readmission after pancreaticoduodenectomy. Such patients may benefit from pre-discharge imaging and/or enhanced follow-up, which may potentially reduce the impact of readmissions.
Aged; Databases, Factual; England; Female; Hospitals, High-Volume; Humans; Male; Middle Aged; Multivariate Analysis; Pancreaticoduodenectomy; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Decision Support Techniques; Patient Readmission
Settore MED/18 - Chirurgia Generale
HPB
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/883602
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