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Factors Influencing Readmission Following Pancreaticoduodenectomy: A Multi-Institutional Study of 1,302 Patients
Syed A Ahmad*1, Jeffrey M Sutton*1, Sanjeet S Grewal*1, David A Kooby*2, Shishir K Maithel*2, David J Bentrem*3, Sharon M Weber4, Clifford S Cho*4, Emily R Winslow*4, Charles R Scoggins*5, Robert C G Martin5, Hong J Kim*6, Nipun B Merchant*7, Alexander A Parikh*7, Michael J Edwards1
1Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH;2Department of Surgery, Emory University, Atlanta, GA;3Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL;4Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI;5Department of Surgery, University of Louisville School of Medicine, Louisville, KY;6Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC;7Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN

OBJECTIVE(S): Morbidity, mortality, and length of hospital stay following pancreaticoduodenectomy (PD) have significantly decreased over the recent decades. Despite these advances, early readmission rates after PD have been reported as high as 50%. Few reports have delineated factors associated with readmission following PD.
METHODS: The medical records of six high-volume institutions were reviewed for patients who underwent PD between 2005 and 2010. Data collection included patient characteristics, medical comorbidities, and perioperative factors. Analysis included readmissions up to 90 days from PD.
RESULTS: 1302 patients underwent PD across all institutions. The 30-day and 90-day readmission rates were 12.4% and 17.7%, respectively. The most common reasons for 30-day readmission included infectious complications (n=66) and delayed gastric emptying (n=23). The most common reasons for readmission after 30 days included infectious complications (n=26) and failure to thrive (n=13). On multivariate analysis, factors associated with higher readmission rates included a diagnosis of chronic pancreatitis; higher transfusion requirements; and post-operative complications including intra-abdominal abscess, pancreatic fistula, and wound infection (all P < 0.02). Factors not associated with higher readmission rates included advanced age, BMI, cardiovascular/pulmonary comorbidities, diabetes, steroid use, Whipple type (standard v. PPPD), pre-operative endobiliary stenting, and vascular reconstruction.
CONCLUSIONS: Factors related to infection, nutritional status, and delayed gastric emptying were the most common reasons for readmission. Post-operative complications including pancreatic fistula predicted higher rates of readmission. Our data represent the first multi-institutional analysis without individual institutional biases. Based on this, our study can serve as a benchmark for complication and readmission rates following PD.

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