A proactive outreach intervention that decreases readmission after hepatectomy

Background: After hepatectomy, 7%–19% of patients are readmitted within 30 days, accounting for substantial cost and poor patient experience. The purpose of this study was to analyze the impact of a proactive outreach intervention on readmissions. Methods: Consecutive patients undergoing hepatectomy by a single surgeon 2012–2016 were identified in a prospectively maintained database. In August 2013 a postoperative intervention was implemented; an advanced practice provider called each patient within 72 hours of discharge. Readmission rates were compared pre- and postintervention using standard statistics. Results: Two hundred thirty-one patients met the inclusion criteria and major hepatectomy was performed in 45.5% of patients. Although the complication rate was similar (25.0% preintervention and 19.4% postintervention, P =.324), readmissions within 30 days of operation decreased from 14.5% pre- to 6.5% postintervention (P =.046). Approximately 30% of outreach interactions required outpatient intervention. Factors associated with readmission on univariate analysis included increased operative time (P =.007), major hepatectomy (P =.012), hemi or extended hepatectomy (P =.032), second stage operation (P =.031), bile leak (P = 0.022), and any complication/modified Accordion complication ≥ 3 within 30 days (P <.0001). On multivariate analysis, lack of post-discharge intervention (P =.012) and bile leak (P =.031) were independently associated with readmission. Conclusion: These data demonstrate the efficacy of a proactive communication intervention after discharge to decrease readmissions after hepatectomy. The additional work created by the intervention is likely offset by decreased inpatient care needs and costs. Identification of high-risk populations and application of technology are likely to lead to further improvements.