TY - JOUR
T1 - Reducing Readmissions after Pancreatectomy
T2 - Limiting Complications and Coordinating the Care Continuum
AU - Ceppa, Eugene P.
AU - Pitt, Henry A.
AU - Nakeeb, Attila
AU - Schmidt, C. Max
AU - Zyromski, Nicholas J.
AU - House, Michael G.
AU - Kilbane, E. Molly
AU - George-Minkner, Alisha N.
AU - Brand, Beth
AU - Lillemoe, Keith D.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Background Recent analyses of gastrointestinal operations document that complications are a key driver of readmissions. Pancreatectomy is a high outlier with respect to readmission. This analysis sought to determine if a multifactorial approach could reduce readmissions after pancreatectomy. Study Design From 2007 to 2012, the number of patients readmitted by 30 days after pancreaticoduodenectomy, and distal and total pancreatectomy was measured. Steps to decrease readmissions were implemented independently at 1-year intervals; these efforts included strategies to reduce complications, creation of a Readmissions Team with a "discharge coach," increased use of home health, preferred relationships with post-acute care facilities, and the adoption of "Project RED" (Re-Engineered Discharge). The ACS NSQIP was used to track 30-day outcomes for all pancreatic resections. The University HealthSystem Consortium was used to determine length of stay index. Results Over 5 years, 1,163 patients underwent proximal (66%), distal (32%), or total pancreatectomy (2%). The observed 30-day mortality was 2.9% for the study period, and the length of stay index (observed/expected days) was 1.10. Neither varied significantly over time. However, 30-day morbidity decreased from 57% to 46%, and proportion of patients with 30-day all-cause readmissions decreased from 23.0% to 11.5% (p = 0.001). Conclusions All-cause 30-day readmissions after pancreatectomy decreased without increasing length of stay. Efforts by surgeons to decrease complications and an increased emphasis on coordination of care may be useful for reducing readmissions.
AB - Background Recent analyses of gastrointestinal operations document that complications are a key driver of readmissions. Pancreatectomy is a high outlier with respect to readmission. This analysis sought to determine if a multifactorial approach could reduce readmissions after pancreatectomy. Study Design From 2007 to 2012, the number of patients readmitted by 30 days after pancreaticoduodenectomy, and distal and total pancreatectomy was measured. Steps to decrease readmissions were implemented independently at 1-year intervals; these efforts included strategies to reduce complications, creation of a Readmissions Team with a "discharge coach," increased use of home health, preferred relationships with post-acute care facilities, and the adoption of "Project RED" (Re-Engineered Discharge). The ACS NSQIP was used to track 30-day outcomes for all pancreatic resections. The University HealthSystem Consortium was used to determine length of stay index. Results Over 5 years, 1,163 patients underwent proximal (66%), distal (32%), or total pancreatectomy (2%). The observed 30-day mortality was 2.9% for the study period, and the length of stay index (observed/expected days) was 1.10. Neither varied significantly over time. However, 30-day morbidity decreased from 57% to 46%, and proportion of patients with 30-day all-cause readmissions decreased from 23.0% to 11.5% (p = 0.001). Conclusions All-cause 30-day readmissions after pancreatectomy decreased without increasing length of stay. Efforts by surgeons to decrease complications and an increased emphasis on coordination of care may be useful for reducing readmissions.
UR - http://www.scopus.com/inward/record.url?scp=84939570050&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84939570050&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2015.05.012
DO - 10.1016/j.jamcollsurg.2015.05.012
M3 - Article
C2 - 26228016
AN - SCOPUS:84939570050
SN - 1072-7515
VL - 221
SP - 708
EP - 716
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 3
M1 - 7918
ER -