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Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation
INTRODUCTION: Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363013/ https://www.ncbi.nlm.nih.gov/pubmed/32671797 http://dx.doi.org/10.1007/s11605-020-04714-3 |
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author | Acher, Alexandra W. Barrett, James R. Schwartz, Patrick B. Stahl, Chris Aiken, Taylor Ronnekleiv-Kelly, Sean Minter, Rebecca M. Leverson, Glen Weber, Sharon Abbott, Daniel E. |
author_facet | Acher, Alexandra W. Barrett, James R. Schwartz, Patrick B. Stahl, Chris Aiken, Taylor Ronnekleiv-Kelly, Sean Minter, Rebecca M. Leverson, Glen Weber, Sharon Abbott, Daniel E. |
author_sort | Acher, Alexandra W. |
collection | PubMed |
description | INTRODUCTION: Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients. METHODS: Hospital cost data from date of discharge to postoperative day 90 were merged with 2008–2018 NSQIP data. Early readmission was within 30 days of surgery, and late readmission was 30 to 90 days from surgery. Regression analyses for readmission controlled for patient comorbidities, complications, and surgeon. RESULTS: Of 230 patients included, 58 (25%) were readmitted. The mean early and late readmission costs were $18,365 ± $20,262 and $24,965 ± $34,435, respectively. Early readmission was associated with index stay deep vein thrombosis (p < 0.01), delayed gastric emptying (p < 0.01), and grade B pancreatic fistula (p < 0.01). High-cost early readmission had long hospital stays or invasive procedures. Common late readmission diagnoses were grade B pancreatic fistula requiring drainage (n = 5, 14%), failure to thrive (n = 4, 14%), and bowel obstruction requiring operation (n = 3, 11%). High-cost late readmissions were associated with chronic complications requiring reoperation. CONCLUSION: Early and late readmissions following pancreaticoduodenectomy differ in both etiology and cost. Early readmission and cost are driven by common complications requiring percutaneous intervention while late readmission and cost are driven by chronic complications and reoperation. Late readmissions are frequent and a significant source of resource utilization. Negotiations of bundled care payment plans should account for significant late readmission resource utilization. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11605-020-04714-3) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7363013 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-73630132020-07-16 Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation Acher, Alexandra W. Barrett, James R. Schwartz, Patrick B. Stahl, Chris Aiken, Taylor Ronnekleiv-Kelly, Sean Minter, Rebecca M. Leverson, Glen Weber, Sharon Abbott, Daniel E. J Gastrointest Surg SSAT Quick Shot Presentation INTRODUCTION: Previous studies on readmission cost in pancreaticoduodenectomy patients use estimated cost data and do not delineate etiology or cost differences between early and late readmissions. We sought to identify relationships between postoperative complication type and readmission timing and cost in pancreaticoduodenectomy patients. METHODS: Hospital cost data from date of discharge to postoperative day 90 were merged with 2008–2018 NSQIP data. Early readmission was within 30 days of surgery, and late readmission was 30 to 90 days from surgery. Regression analyses for readmission controlled for patient comorbidities, complications, and surgeon. RESULTS: Of 230 patients included, 58 (25%) were readmitted. The mean early and late readmission costs were $18,365 ± $20,262 and $24,965 ± $34,435, respectively. Early readmission was associated with index stay deep vein thrombosis (p < 0.01), delayed gastric emptying (p < 0.01), and grade B pancreatic fistula (p < 0.01). High-cost early readmission had long hospital stays or invasive procedures. Common late readmission diagnoses were grade B pancreatic fistula requiring drainage (n = 5, 14%), failure to thrive (n = 4, 14%), and bowel obstruction requiring operation (n = 3, 11%). High-cost late readmissions were associated with chronic complications requiring reoperation. CONCLUSION: Early and late readmissions following pancreaticoduodenectomy differ in both etiology and cost. Early readmission and cost are driven by common complications requiring percutaneous intervention while late readmission and cost are driven by chronic complications and reoperation. Late readmissions are frequent and a significant source of resource utilization. Negotiations of bundled care payment plans should account for significant late readmission resource utilization. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11605-020-04714-3) contains supplementary material, which is available to authorized users. Springer US 2020-07-15 2021 /pmc/articles/PMC7363013/ /pubmed/32671797 http://dx.doi.org/10.1007/s11605-020-04714-3 Text en © The Society for Surgery of the Alimentary Tract 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | SSAT Quick Shot Presentation Acher, Alexandra W. Barrett, James R. Schwartz, Patrick B. Stahl, Chris Aiken, Taylor Ronnekleiv-Kelly, Sean Minter, Rebecca M. Leverson, Glen Weber, Sharon Abbott, Daniel E. Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title | Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title_full | Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title_fullStr | Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title_full_unstemmed | Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title_short | Early vs Late Readmissions in Pancreaticoduodenectomy Patients: Recognizing Comprehensive Episodic Cost to Help Guide Bundled Payment Plans and Hospital Resource Allocation |
title_sort | early vs late readmissions in pancreaticoduodenectomy patients: recognizing comprehensive episodic cost to help guide bundled payment plans and hospital resource allocation |
topic | SSAT Quick Shot Presentation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363013/ https://www.ncbi.nlm.nih.gov/pubmed/32671797 http://dx.doi.org/10.1007/s11605-020-04714-3 |
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