Reducing Readmissions after Pancreatectomy

Limiting Complications and Coordinating the Care Continuum

Eugene P. Ceppa, Henry A. Pitt, Attila Nakeeb, C. Schmidt, Nicholas Zyromski, Michael House, E. Molly Kilbane, Alisha N. George-Minkner, Beth Brand, Keith D. Lillemoe

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number7918
Pages (from-to)708-716
Number of pages9
JournalJournal of the American College of Surgeons
Volume221
Issue number3
DOIs
StatePublished - Sep 1 2015

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Pancreatectomy
Continuity of Patient Care
Length of Stay
Subacute Care
Pancreaticoduodenectomy
Morbidity
Mortality
Health

ASJC Scopus subject areas

  • Surgery

Cite this

Reducing Readmissions after Pancreatectomy : Limiting Complications and Coordinating the Care Continuum. / Ceppa, Eugene P.; Pitt, Henry A.; Nakeeb, Attila; Schmidt, C.; Zyromski, Nicholas; House, Michael; Kilbane, E. Molly; George-Minkner, Alisha N.; Brand, Beth; Lillemoe, Keith D.

In: Journal of the American College of Surgeons, Vol. 221, No. 3, 7918, 01.09.2015, p. 708-716.

Research output: Contribution to journalArticle

Ceppa, Eugene P. ; Pitt, Henry A. ; Nakeeb, Attila ; Schmidt, C. ; Zyromski, Nicholas ; House, Michael ; Kilbane, E. Molly ; George-Minkner, Alisha N. ; Brand, Beth ; Lillemoe, Keith D. / Reducing Readmissions after Pancreatectomy : Limiting Complications and Coordinating the Care Continuum. In: Journal of the American College of Surgeons. 2015 ; Vol. 221, No. 3. pp. 708-716.
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abstract = "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.",
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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.

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