The association of length of hospital stay with readmission after elective pancreatic resection

Aditya Mazmudar, Joshua Castle, Anthony D. Yang, David J. Bentrem*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objective: The aim of this study was to identify if prolonged length of hospital stay was protective for certain post-discharge complications requiring readmission after pancreatectomy. Methods: Patients undergoing elective pancreatectomy from 2012 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate regression analyses were conducted to elucidate the association of length of hospital stay (LOS), in-hospital complications, and post-discharge complications with 30-day hospital readmission. Results: Mean LOS for the readmitted versus not readmitted cohort was 9.01 and 10.36, respectively (P < 0.001). Approximately half of hospital readmissions occur within 7 days of discharge from the hospital. The readmission rate (after hospital discharge) for patients with any in-hospital complication was 13.2%. On the other hand, the readmission rate for patients with any post-discharge complication was 70.8%. Readmission rates were above 85% for patients with the following post-discharge complications: organ/space surgical site infection (SSI), pneumonia, ventilator dependence greater than 48 h, progressive renal insufficiency, sepsis, and septic shock. In a multivariate logistic regression model, prolonged LOS reduced the odds of any post-discharge complication requiring readmission (OR = 0.68, P = 0.01). Specifically, prolonged LOS reduced the odds of a post-discharge organ/space SSI requiring readmission (OR = 0.72, P = 0.02). Conclusion: Readmission after pancreatectomy primarily occurs due to a new post-discharge event. Furthermore, increased LOS is protective for readmission for post-pancreatectomy complications, particularly those due to post-discharge organ space SSIs. Our findings suggest that solely focusing on reducing LOS in pancreatectomy may lead to the unintended consequence of increasing readmission rates.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalJournal of surgical oncology
Volume118
Issue number1
DOIs
StatePublished - Jul 1 2018

Keywords

  • NSQIP
  • length of stay
  • organ space surgical site infections
  • readmission

ASJC Scopus subject areas

  • Surgery
  • Oncology

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