Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies
Open accessAbstract
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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Disseminated cancer, a pre-operative open wound, and dyspnea are examples of comorbidities tied to early readmission in prior studies.
“Examples of existing comorbidities associated with early readmission include disseminated cancer, pre-operative open wound, and dyspnea.”
From Clinical predictors and outcome implications of early readmission in lung transplant recipients (2017) · cites this paper as [12]
The Results (Readmission analyses; page unavailable) associate a higher overall comorbidity score with readmission within 30 days. The paper does not identify disseminated cancer, a pre-operative open wound, or dyspnea as individual readmission risk factors; searches for those terms found no such analysis. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPrior work has linked certain pre-existing conditions to higher 30-day readmission rates after surgery.
“This finding is inconsistent with other studies, in which authors have observed significant relationships between specific pre-existing conditions and increased rates of 30-day readmission in surgical patients.7,12”
From Clinical predictors and outcome implications of early readmission in lung transplant recipients (2017) · cites this paper as [12]
The Results (Readmission analyses; page unavailable) report a significant association between a higher Elixhauser comorbidity score and increased 30-day readmission after hepato-pancreato-biliary surgery. The paper measures pre-existing conditions but reports this finding for a composite score, not significant relationships with specific individual conditions. (LLM, conf=0.86)
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Comorbidity measures for use with administrative data.
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Clinical predictors and outcome implications of early readmission in lung transplant recipients
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- Authors
- Schneider, E. B., Hyder, O., Wolfgang, C. L., Hirose, K., Choti, M. A., Makary, M. A., Herman, J. M., Cameron, J. L., & Pawlik, T. M.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Pawlik, Timothy M.
- ORCID
- Venue
- Journal of the American College of Surgeons
- Published
- 2012-11
- Volume
- 215
- Issue
- 5
- Pages
- 607-615
- ISSN
- 1072-7515 (ISSN-L)
- PMC
- PMC4051393
- OpenAlex
- W1977427217
- Cited by
- 118
- References
- 23
- Citations by year
- 2025: 4 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 9 · 2020: 10 · 2019: 5 · 2018: 14 · 2017: 6 · 2016: 8 · 2015: 22 · 2014: 21 · 2013: 10 · 2012: 1
- FWCI
- 8.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P30CA006973)
- Topics
- Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Keywords
- hospital readmission, postoperative mortality, hepatopancreatobiliary surgery, pancreatic cancer surgery, 30-day readmission, Elixhauser comorbidity index, preoperative comorbidities, length of hospital stay, Medicare beneficiaries, older adults, risk factors for readmission, temporal trends in surgical outcomes, SEER
- MeSH terms
- Aged, Aged, 80 and over, Biliary Tract Neoplasms, Female, Medicare, Humans, Length of Stay, Liver Neoplasms, Male, Pancreatic Neoplasms, Patient Readmission, Postoperative Complications, Retrospective Studies, Digestive System Surgical Procedures, United States, Cohort Studies, Multivariate Analysis, Logistic Models, Survival Analysis, Treatment Outcome, Hospital Mortality, SEER Program
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