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

Boteon, Amanda P C S, Boteon, Yuri L, Hodson, James, Osborne, Helen, Isaac, John, Marudanayagam, Ravi, Mirza, Darius F, Muiesan, Paolo, Roberts, John K and Sutcliffe, Robert P (2019) Multivariable analysis of predictors of unplanned hospital readmission after pancreaticoduodenectomy: development of a validated risk score. HPB : the official journal of the International Hepato Pancreato Biliary Association, 21 (1). pp. 26-33. ISSN 1477-2574.

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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.

Item Type: Article
Subjects: WI Digestive system. Gastroenterology
WO Surgery
Related URLs:
Depositing User: Stephen Yates
Date Deposited: 21 Apr 2020 15:00
Last Modified: 10 Jul 2020 13:27
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3003

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