Composite Length of Stay, An Outcome Measure of Postoperative and Readmission Length of Stays in Pancreatoduodenectomy.
Composite length of stay
Length of stay
MAGS
Modified Accordion Grading System
Pancreatoduodenectomy
Postopertaive complications
Postopertaive length of stay
Readmission length of stay
Readmission rate
Whipple procedure
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
21
09
2019
accepted:
12
11
2019
pubmed:
18
12
2019
medline:
15
4
2021
entrez:
18
12
2019
Statut:
ppublish
Résumé
Postoperative length of stay (PLOS) and readmission rate are pancreatoduodenectomy (PD) outcome measures, which are reported individually but may be interrelated. The purpose of this study was to evaluate how well a composite length of stay measure (CLOS) that included PLOS and readmission length of stay describes outcomes. To do so, we evaluated how well CLOS correlated to postoperative complications absolutely and compared to PLOS. A total of 668 PDs performed between 2011 and 2018 were evaluated. CLOS was calculated from PLOS and readmission length of stay. Complication severity was judged by the Modified Accordion Grading System (MAGS). Multinomial logistical regression models (MLRM) were used to investigate the relationship between either PLOS or CLOS and complications. Multilevel and pairwise area under curves (AUC) using SAS macro %MultAUC were provided for both models. A total of 432 of 668 patients (65%) developed complications. One hundred seventy-seven patients (27%) were readmitted. Mean PLOS was 10.2 days (7.1 SD) and mean CLOS was 12.3 days (10.1 SD). PLOS and CLOS both were correlated linearly to MAGS grade. Spearman correlation coefficient for CLOS vs. MAGS of 0.68 was higher than that of 0.49 for PLOS vs. MAGS. Multilevel AUC from MLRM using PLOS was 0.66, but multilevel AUC from MLRM using CLOS was 0.71. CLOS provides an accurate estimate of hospital day utilization per patient for PD, reflecting not only the basal hospital recovery time for PD but the added time needed because of readmissions due to complications. It is tightly correlated to number and severity of postoperative complications.
Identifiants
pubmed: 31845140
doi: 10.1007/s11605-019-04475-8
pii: 10.1007/s11605-019-04475-8
pmc: PMC7295670
mid: NIHMS1579347
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2062-2069Subventions
Organisme : NCI NIH HHS
ID : SPORE Grant 5P50 CA196510
Pays : United States
Organisme : NCI NIH HHS
ID : Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR002344
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA091842
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR000449
Pays : United States
Organisme : NCI NIH HHS
ID : P50 CA196510
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002345
Pays : United States
Organisme : NIH HHS
ID : UL1 TR000449
Pays : United States
Références
Emick DM, Riall TS, Cameron JL, Winter JM, Lillemoe KD, Coleman J, et al. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg. 2006;10:1243-52; discussion 52-3.
doi: 10.1016/j.gassur.2006.08.016
Kent TS, Sachs TE, Callery MP, Vollmer CM, Jr. Readmission after major pancreatic resection: a necessary evil? J Am Coll Surg. 2011;213:515-23.
doi: 10.1016/j.jamcollsurg.2011.07.009
Ahmad SA, Edwards MJ, Sutton JM, Grewal SS, Hanseman DJ, Maithel SK, et al. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg. 2012;256:529-37.
doi: 10.1097/SLA.0b013e318265ef0b
Kastenberg ZJ, Morton JM, Visser BC, Norton JA, Poultsides GA. Hospital readmission after a pancreaticoduodenectomy: an emerging quality metric? HPB. 2013;15:142-8.
doi: 10.1111/j.1477-2574.2012.00563.x
Hyder O, Dodson RM, Nathan H, Schneider EB, Weiss MJ, Cameron JL, et al. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surgery. 2013;14812:1095-102.
doi: 10.1001/jamasurg.2013.2509
Sadot E, Brennan MF, Lee SY, Allen PJ, Gonen M, Groeger JS, et al. Readmission after pancreatic resection: causes and causality pattern. Ann Surg Oncol. 2014;21:4342-50.
doi: 10.1245/s10434-014-3841-0
Sutton JM, Wilson GC, Wima K, Hoehn RS, Cutler Quillin R, 3rd, Hanseman DJ, et al. Readmission After Pancreaticoduodenectomy: The Influence of the Volume Effect Beyond Mortality. Ann Surg Oncol. 2015;22:3785-92.
doi: 10.1245/s10434-015-4451-1
Schneider EB, Canner JK, Gani F, Kim Y, Ejaz A, Spolverato G, et al. Early versus late hospital readmission after pancreaticoduodenectomy. Journal of Surgical Research. 2015;196(1):74-81.
doi: 10.1016/j.jss.2015.02.043
Mazmudar A, Castle J, Yang AD, Bentrem DJ. The association of length of hospital stay with readmission after elective pancreatic resection. J Surg Oncol. 2018;118:7-14.
doi: 10.1002/jso.25093
Catena R, Dopson S, Holweg M. On the tension between standardized and customized policies in health care: The case of length-of-stay reduction. J Oper Manag. 2019;65:1-16.
doi: 10.1002/joom.1020
Porembka MR, Hall BL, Hirbe M, Strasberg SM. Quantitative weighting of postoperative complications based on the accordion severity grading system: demonstration of potential impact using the american college of surgeons national surgical quality improvement program. J Am Coll Surg. 2010;210:286-98.
doi: 10.1016/j.jamcollsurg.2009.12.004
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518-26.
pubmed: 1598671
Strasberg SM, Linehan DC, Hawkins WG. The accordion severity grading system of surgical complications. Ann Surg. 2009;250:177-86.
doi: 10.1097/SLA.0b013e3181afde41
Kendrick ML, van Hilst J, Boggi U, de Rooij T, Walsh RM, Zeh HJ, et al. Minimally invasive pancreatoduodenectomy. HPB. 2017;19:215-24.
doi: 10.1016/j.hpb.2017.01.023
Nassour I, Wang SC, Christie A, Augustine MM, Porembka MR, Yopp AC, et al. Minimally Invasive Versus Open Pancreaticoduodenectomy: A Propensity-matched Study From a National Cohort of Patients. Ann Surg. 2018;268(1):151-7.
Beal EW, Bagante F, Paredes A, Chen Q, Akgul O, Merath K, et al. Index versus Non-index Readmission After Hepato-Pancreato-Biliary Surgery: Where Do Patients Go to Be Readmitted? J Gastrointest Surg. 2019;23:702-11.
doi: 10.1007/s11605-018-3882-y