Classification of Post-pancreatectomy Readmissions and Opportunities for Targeted Mitigation Strategies

Objective: Within a learning health system paradigm, this study sought to evaluate reasons for readmission to identify opportunities for improvement. Background: Post-pancreatectomy readmission rates have remained constant despite improved index hospitalization metrics. Methods: We performed a single-institution case-control study of consecutive patients with pancreatectomy (October 2016 to April 2022). Complications were prospectively graded in biweekly faculty and advanced practice provider meetings. We analyzed risk factors during index hospitalization and categorized indications for 90-day readmissions. Results: A total of 835 patients, median age 65 years and 51% (427/835) males, underwent 64% (534/835) pancreatoduodenectomies, 34% (280/835) distal pancreatectomies, and 3% (21/835) other resections. Twenty-four percent (204/835) of patients were readmitted. The primary indication for readmission was technical in 51% (105/204), infectious in 17% (35/204), and medical/metabolic in 31% (64/204) of patients. Procedures were required in 77% (81/105) and 60% (21/35) of technical and infectious readmissions, respectively, while 66% (42/64) of medical/metabolic readmissions were managed noninvasively. During the index hospitalization, benign pathology [odds ratio (OR): 1.8, P=0.049], biochemical pancreatic leak (OR: 2.3, P=0.001), bile/gastric/chyle leak (OR: 6.4, P=0.001), organ-space infection (OR: 3.4, P=0.007), undrained fluid on imaging (OR: 2.4, P=0.045), and increasing white blood cell count (OR: 1.7, P=0.045) were independently associated with odds of readmission. Conclusions: Most readmissions following pancreatectomy were technical in origin. Patients with complications during the index hospitalization, increasing white blood cell count, or undrained fluid before discharge were at the highest risk for readmission. Predischarge risk stratification of readmission risk factors and augmentation of in-clinic resources may be strategies to reduce readmission rates.