Readmission after pancreatectomy for pancreatic cancer in medicare patients

Deepthi M. Reddy, Courtney Townsend, Yong Fang Kuo, Jean L. Freeman, James Goodwin, Taylor S. Riall

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Objective The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer. Methods We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy. Results We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer. The in-hospital mortality was 7.5%. The overall Kaplan-Meier readmission rate was 16% at 30 days and 53% at 1 year, accounting for 15,409 additional hospital days. Early readmissions were clearly related to operative complications in 80% of cases and unrelated diagnoses in 20% of cases. Late readmissions were related to recurrence in 48%, operative complications in 25%, and unrelated diagnoses in 27% of cases. In a multivariate analysis, only distal pancreatic resection (P=0.02) and initial postoperative length of stay ≥10 days (P=0.03) predicted early readmission. When compared to patients not readmitted, patients readmitted early had worse median survival (11.8 vs.16.5 months, P=0.04), but the 5-year survival was identical (18%). Late readmission was associated with worse median and 5-year survival (19.4 vs. 12.1 months, 12% vs. 21%, P<0.0001). Conclusions Our study demonstrates overall 30-day and 1-year readmission rates of 16% and 53%. The majority of early readmissions were related to postoperative complications but not related to patient and tumor characteristics. Complications causing early readmission are a cause of early mortality and are potentially preventable. Conversely, late readmissions are related to disease progression and are a marker of early mortality and not the cause.

Original languageEnglish (US)
Pages (from-to)1963-1975
Number of pages13
JournalJournal of Gastrointestinal Surgery
Volume13
Issue number11
DOIs
StatePublished - 2009

Fingerprint

Pancreatectomy
Medicare
Pancreatic Neoplasms
Survival
Patient Readmission
Mortality
Hospital Mortality
Disease Progression
Length of Stay
Epidemiology
Hospitalization
Multivariate Analysis
Recurrence
Population
Neoplasms

Keywords

  • Readmission. Pancreatic resection. Kaplan-Meier. Operative complications

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology
  • Medicine(all)

Cite this

Readmission after pancreatectomy for pancreatic cancer in medicare patients. / Reddy, Deepthi M.; Townsend, Courtney; Kuo, Yong Fang; Freeman, Jean L.; Goodwin, James; Riall, Taylor S.

In: Journal of Gastrointestinal Surgery, Vol. 13, No. 11, 2009, p. 1963-1975.

Research output: Contribution to journalArticle

@article{748dadb78a044ffa9f411b5639e17e83,
title = "Readmission after pancreatectomy for pancreatic cancer in medicare patients",
abstract = "Objective The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer. Methods We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy. Results We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer. The in-hospital mortality was 7.5{\%}. The overall Kaplan-Meier readmission rate was 16{\%} at 30 days and 53{\%} at 1 year, accounting for 15,409 additional hospital days. Early readmissions were clearly related to operative complications in 80{\%} of cases and unrelated diagnoses in 20{\%} of cases. Late readmissions were related to recurrence in 48{\%}, operative complications in 25{\%}, and unrelated diagnoses in 27{\%} of cases. In a multivariate analysis, only distal pancreatic resection (P=0.02) and initial postoperative length of stay ≥10 days (P=0.03) predicted early readmission. When compared to patients not readmitted, patients readmitted early had worse median survival (11.8 vs.16.5 months, P=0.04), but the 5-year survival was identical (18{\%}). Late readmission was associated with worse median and 5-year survival (19.4 vs. 12.1 months, 12{\%} vs. 21{\%}, P<0.0001). Conclusions Our study demonstrates overall 30-day and 1-year readmission rates of 16{\%} and 53{\%}. The majority of early readmissions were related to postoperative complications but not related to patient and tumor characteristics. Complications causing early readmission are a cause of early mortality and are potentially preventable. Conversely, late readmissions are related to disease progression and are a marker of early mortality and not the cause.",
keywords = "Readmission. Pancreatic resection. Kaplan-Meier. Operative complications",
author = "Reddy, {Deepthi M.} and Courtney Townsend and Kuo, {Yong Fang} and Freeman, {Jean L.} and James Goodwin and Riall, {Taylor S.}",
year = "2009",
doi = "10.1007/s11605-009-1006-4",
language = "English (US)",
volume = "13",
pages = "1963--1975",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",
number = "11",

}

TY - JOUR

T1 - Readmission after pancreatectomy for pancreatic cancer in medicare patients

AU - Reddy, Deepthi M.

AU - Townsend, Courtney

AU - Kuo, Yong Fang

AU - Freeman, Jean L.

AU - Goodwin, James

AU - Riall, Taylor S.

PY - 2009

Y1 - 2009

N2 - Objective The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer. Methods We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy. Results We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer. The in-hospital mortality was 7.5%. The overall Kaplan-Meier readmission rate was 16% at 30 days and 53% at 1 year, accounting for 15,409 additional hospital days. Early readmissions were clearly related to operative complications in 80% of cases and unrelated diagnoses in 20% of cases. Late readmissions were related to recurrence in 48%, operative complications in 25%, and unrelated diagnoses in 27% of cases. In a multivariate analysis, only distal pancreatic resection (P=0.02) and initial postoperative length of stay ≥10 days (P=0.03) predicted early readmission. When compared to patients not readmitted, patients readmitted early had worse median survival (11.8 vs.16.5 months, P=0.04), but the 5-year survival was identical (18%). Late readmission was associated with worse median and 5-year survival (19.4 vs. 12.1 months, 12% vs. 21%, P<0.0001). Conclusions Our study demonstrates overall 30-day and 1-year readmission rates of 16% and 53%. The majority of early readmissions were related to postoperative complications but not related to patient and tumor characteristics. Complications causing early readmission are a cause of early mortality and are potentially preventable. Conversely, late readmissions are related to disease progression and are a marker of early mortality and not the cause.

AB - Objective The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer. Methods We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy. Results We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer. The in-hospital mortality was 7.5%. The overall Kaplan-Meier readmission rate was 16% at 30 days and 53% at 1 year, accounting for 15,409 additional hospital days. Early readmissions were clearly related to operative complications in 80% of cases and unrelated diagnoses in 20% of cases. Late readmissions were related to recurrence in 48%, operative complications in 25%, and unrelated diagnoses in 27% of cases. In a multivariate analysis, only distal pancreatic resection (P=0.02) and initial postoperative length of stay ≥10 days (P=0.03) predicted early readmission. When compared to patients not readmitted, patients readmitted early had worse median survival (11.8 vs.16.5 months, P=0.04), but the 5-year survival was identical (18%). Late readmission was associated with worse median and 5-year survival (19.4 vs. 12.1 months, 12% vs. 21%, P<0.0001). Conclusions Our study demonstrates overall 30-day and 1-year readmission rates of 16% and 53%. The majority of early readmissions were related to postoperative complications but not related to patient and tumor characteristics. Complications causing early readmission are a cause of early mortality and are potentially preventable. Conversely, late readmissions are related to disease progression and are a marker of early mortality and not the cause.

KW - Readmission. Pancreatic resection. Kaplan-Meier. Operative complications

UR - http://www.scopus.com/inward/record.url?scp=77952982095&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952982095&partnerID=8YFLogxK

U2 - 10.1007/s11605-009-1006-4

DO - 10.1007/s11605-009-1006-4

M3 - Article

C2 - 19760307

AN - SCOPUS:77952982095

VL - 13

SP - 1963

EP - 1975

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 11

ER -