Skip to main content
Erschienen in: World Journal of Surgery 7/2019

06.03.2019 | Original Scientific Report

Possible Preventable Causes of Unplanned Readmission After Elective Liver Resection, Results from a Non-academic Referral HPB Center

verfasst von: G. W. de Klein, R. M. Brohet, M. S. L. Liem, J. M. Klaase

Erschienen in: World Journal of Surgery | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Unplanned readmission is a common event after liver resection, and it is a burden for both patients and healthcare policy makers. This study evaluates the incidence of and reasons for unplanned readmission after liver resection, in order to identify possible preventable causes.

Methods

In this single-center cohort study, data from patients who underwent liver resection for both malignant and benign indications from 2001 to 2016 at our institute were collected from a database with prospective data. Readmissions were analyzed for their reasons and risk factors. Patients with general complaints with no specific complications were categorized as failure to thrive.

Results

In 406 patients, the readmission rate was 11.6%. Most patients were readmitted because of failure to thrive (35%), deep and superficial surgical site infection (28%), or cardiopulmonary complications (15%). A multivariate analysis revealed that unplanned readmission was associated with the occurrence of complications during index admission—with an odds ratio of 4.69 (CI 2.41–9.12, p < 0.001).

Conclusion

Readmission occurs in more than 1 in 10 patients after liver resection, and it is associated with a complicated course during index admission. One-third of readmissions occur because of failure to thrive and might be preventable. Future research in strategies to reduce readmission rates should focus on both the prevention of complications during index admission and programs at the interface between primary and secondary care.
Literatur
1.
Zurück zum Zitat Barbas AS, Turley RS, Mallipeddi MK, Lidsky ME, Reddy SK, White RR, Clary BM (2013) Examining reoperation and readmission after hepatic surgery. J Am Coll Surg 216(5):915–923CrossRefPubMed Barbas AS, Turley RS, Mallipeddi MK, Lidsky ME, Reddy SK, White RR, Clary BM (2013) Examining reoperation and readmission after hepatic surgery. J Am Coll Surg 216(5):915–923CrossRefPubMed
2.
Zurück zum Zitat Spolverato G, Ejaz A, Kim Y, Weiss M, Wolfgang CL, Hirose K, Pawlik TM (2014) Readmission incidence and associated factors after a hepatic resection at a major hepato-pancreatico-biliary academic centre. HPB 16(11):972–978CrossRefPubMedPubMedCentral Spolverato G, Ejaz A, Kim Y, Weiss M, Wolfgang CL, Hirose K, Pawlik TM (2014) Readmission incidence and associated factors after a hepatic resection at a major hepato-pancreatico-biliary academic centre. HPB 16(11):972–978CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Kimbrough CW, Agle SC, Scoggins CR, Martin RC, Marvin MR, Davis EG, McMasters KM, Jones CM (2014) Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. Surgery 156(4):1039–1046CrossRefPubMed Kimbrough CW, Agle SC, Scoggins CR, Martin RC, Marvin MR, Davis EG, McMasters KM, Jones CM (2014) Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. Surgery 156(4):1039–1046CrossRefPubMed
4.
Zurück zum Zitat Tamandl D, Butte JM, Allen PJ, D’Angelica MI, DeMatteo RP, Groeger JS, Jarnagin WR, Fong Y (2015) Hospital readmissions after liver surgery for metastatic colorectal cancer. Surgery 157(2):231–238CrossRefPubMed Tamandl D, Butte JM, Allen PJ, D’Angelica MI, DeMatteo RP, Groeger JS, Jarnagin WR, Fong Y (2015) Hospital readmissions after liver surgery for metastatic colorectal cancer. Surgery 157(2):231–238CrossRefPubMed
5.
Zurück zum Zitat Narula N, Kim BJ, Davis CH, Dewhurst WL, Samp LA, Aloia TA (2018) A proactive outreach intervention that decreases readmission after hepatectomy. Surgery 163(4):703–708CrossRefPubMed Narula N, Kim BJ, Davis CH, Dewhurst WL, Samp LA, Aloia TA (2018) A proactive outreach intervention that decreases readmission after hepatectomy. Surgery 163(4):703–708CrossRefPubMed
6.
Zurück zum Zitat Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Christensen BM, Kehlet H, Hillingso JG (2013) Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg 100(1):138–143CrossRefPubMed Schultz NA, Larsen PN, Klarskov B, Plum LM, Frederiksen HJ, Christensen BM, Kehlet H, Hillingso JG (2013) Evaluation of a fast-track programme for patients undergoing liver resection. Br J Surg 100(1):138–143CrossRefPubMed
8.
Zurück zum Zitat Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK (2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369(12):1134–1142CrossRefPubMedPubMedCentral Tsai TC, Joynt KE, Orav EJ, Gawande AA, Jha AK (2013) Variation in surgical-readmission rates and quality of hospital care. N Engl J Med 369(12):1134–1142CrossRefPubMedPubMedCentral
9.
10.
Zurück zum Zitat van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH (2008) Enhanced recovery after surgery (ERAS) group. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg 95(8):969–975CrossRefPubMed van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH (2008) Enhanced recovery after surgery (ERAS) group. Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg 95(8):969–975CrossRefPubMed
11.
Zurück zum Zitat Spelt L, Ansari D, Sturesson C, Tingstedt B, Andersson R (2011) Fast-track programmes for hepatopancreatic resections: where do we stand? HPB 13(12):833–838CrossRefPubMedPubMedCentral Spelt L, Ansari D, Sturesson C, Tingstedt B, Andersson R (2011) Fast-track programmes for hepatopancreatic resections: where do we stand? HPB 13(12):833–838CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat He F, Lin X, Xie F, Huang Y, Yuan R (2015) The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol 17(9):694–701CrossRefPubMed He F, Lin X, Xie F, Huang Y, Yuan R (2015) The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol 17(9):694–701CrossRefPubMed
13.
Zurück zum Zitat Connor S, Cross A, Sakowska M, Linscott D, Woods J (2013) Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB 15(4):294–301CrossRefPubMed Connor S, Cross A, Sakowska M, Linscott D, Woods J (2013) Effects of introducing an enhanced recovery after surgery programme for patients undergoing open hepatic resection. HPB 15(4):294–301CrossRefPubMed
14.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Spolverato G, Maqsood H, Vitale A, Alexandrescu S, Marques HP, Aldrighetti L, Gamblin TC, Pulitano C, Bauer TW, Shen F, Poultsides G, Maithel S, Marsh JW, Pawlik TM (2015) Readmission after liver resection for Intrahepatic cholangiocarcinoma: a multi-institutional analysis. J Gastrointest Surg 19(7):1334–1341CrossRefPubMed Spolverato G, Maqsood H, Vitale A, Alexandrescu S, Marques HP, Aldrighetti L, Gamblin TC, Pulitano C, Bauer TW, Shen F, Poultsides G, Maithel S, Marsh JW, Pawlik TM (2015) Readmission after liver resection for Intrahepatic cholangiocarcinoma: a multi-institutional analysis. J Gastrointest Surg 19(7):1334–1341CrossRefPubMed
16.
Zurück zum Zitat Kim S, Maynard EC, Shah MB, Daily MF, Tzeng CW, Davenport DL, Gedaly R (2015) Risk factors for 30-day readmissions after hepatectomy: analysis of 2444 patients from the ACS-NSQIP database. J Gastrointest Surg 19(2):266–271CrossRefPubMed Kim S, Maynard EC, Shah MB, Daily MF, Tzeng CW, Davenport DL, Gedaly R (2015) Risk factors for 30-day readmissions after hepatectomy: analysis of 2444 patients from the ACS-NSQIP database. J Gastrointest Surg 19(2):266–271CrossRefPubMed
17.
Zurück zum Zitat Egger ME, Squires MH 3rd, Kooby DA, Maithel SK, Cho CS, Weber SM, Winslow ER, Martin RC 2nd, McMasters KM, Scoggins CR (2015) Risk stratification for readmission after major hepatectomy: development of a readmission risk score. J Am Coll Surg 220(4):640–648CrossRefPubMed Egger ME, Squires MH 3rd, Kooby DA, Maithel SK, Cho CS, Weber SM, Winslow ER, Martin RC 2nd, McMasters KM, Scoggins CR (2015) Risk stratification for readmission after major hepatectomy: development of a readmission risk score. J Am Coll Surg 220(4):640–648CrossRefPubMed
Metadaten
Titel
Possible Preventable Causes of Unplanned Readmission After Elective Liver Resection, Results from a Non-academic Referral HPB Center
verfasst von
G. W. de Klein
R. M. Brohet
M. S. L. Liem
J. M. Klaase
Publikationsdatum
06.03.2019
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 7/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-04970-8

Weitere Artikel der Ausgabe 7/2019

World Journal of Surgery 7/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.