PTU-077 Unplanned hospital readmission within 30 days after liver and pancreatic resection

Abstract

Introduction: Due to limited resources within the NHS, clinicians in the UK are under constant pressure to discharge patients rapidly, even after major surgery. There is a concern that premature discharge may lead to high readmission rates and worsen clinical outcomes. The aim of this study was to evaluate the incidence and outcome of unplanned hospital readmission after liver and pancreatic resection. Methods: Patients who underwent liver or pancreatic resection between January and December 2010 were identified from a prospective database. Potential risk factors for unplanned readmission within 30 days of discharge from hospital were evaluated. Reasons for readmission were categorized as minor (Clavien grade 1-2) or major complications (grade 3-4), and mortality after readmission was also assessed. Results: Median hospital stay after liver and pancreatic resections were 6 (range 4-66) and 9 days (5-225). 14/174 (8%) patients were readmitted after liver resection. The type of liver resection was associated with readmission (major 12.5% v minor 3%; p = 0.03). Of the readmitted patients, 7 (50%) had major complications, including 4 who had an uncomplicated index admission and 2 patients died. 10/100 (10%) patients were readmitted after pancreatic resection. Readmission was more likely in patients with pancreatic fistula (30% v 8%; p = 0.06) or white cell count >15 x 109/L at the time of discharge (38% v 6%; p = 0.003). Of the readmitted patients, 4 (40%) had major complications, including 3 who needed urgent embolization. Two patients in this group died. Conclusion: Hospital readmission rates after liver and pancreatic resection are acceptable. However, readmitted patients have a very high morbidity, often requiring urgent intervention only available at a specialist centre. Efficient communication and rapid transfer of patients to a centre with the available expertise is vitally important to prevent delayed deaths after major liver or pancreatic resections.