Kent et al reviewed reasons for hospital readmission following pancreatic resection. The reasons for hospital readmission often relate to the complexity of the conditions being treated rather than the quality of care receivied. The authors are from Beth Israel Deaconess Medical Center in Boston.


Patient selection: pancreatic resection


Reasons for hospital readmission followng surgery:

(1) pancreatic fistula

(2) delayed gastric emptying

(3) portal vein thrombosis

(4) bile leak

(5) gastrointestinal bleeding

(6) pancreatitis

(7) abdominal abscess

(8) enteric fistula

(9) surgical site infection

(10) damage to J-tube

(11) Clostridium difficile colitis

(12) drug reaction (antibiotic, other)

(13) dehydration

(14) refusal to eat

(15) generalized weakness

(16) inadequate disposition (unable to be cared for at home, etc)

(17) decubital ulcer

(18) ischemic vascular disease (ischemic toe, transient ischemic attack, other)

(19) psychiatric

(20) thrombocytosis

(21) diarrhea (not due to C. difficile colitis)

(22) elevated INR

(23) abdominal pain

(24) constipation


These can be classified into groups:

(1) procedure-specific complications

(2) general postoperative surgical complications

(3) failure to thrive after surgery

(4) medical problem

(5) need for diagnostic evaluation


The authors recommend not using hospital readmission as a measure of quality since it may be a function of a serious underlying disease.


Hospital readmission can be reduced (but not eliminated) by:

(1) careful patient selection

(2) limiting surgery to certain surgical centers

(3) using teams of highly experienced providers

(4) establishing and following a care path

(5) careful followup of high risk patients

(6) careful discharge planning


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