|Authors||Egger ME, Squires MH, Kooby DA, Maithel SK, Cho CS, Weber SM, Winslow ER, Martin RC, McMasters KM, Scoggins CR|
|Journal||J. Am. Coll. Surg. Volume: 220 Issue: 4 Pages: 640-8|
|Publish Date||2015 Apr|
Hospital readmission is becoming a quality measure, despite poor understanding of the risks of readmission. This study examines readmission risk factors after major hepatectomy and develops a predictive model.A retrospective review was performed on patients who had undergone major hepatectomy at 1 of 3 academic centers between the years 2000 and 2012. Clinicopathologic and perioperative data were analyzed for risk factors of 90-day readmission using logistic regression. A readmission risk score was developed and validated in a separate validation set to determine its predictive value.Of 1,184 hepatectomies performed, 17.3% of patients were readmitted within 90 days. Factors associated with readmission include operative blood loss (odds ratio [OR] = 1.00; 95% CI, 1.000-1.001), any postoperative complication (OR = 4.3; 95% CI, 1.8-10.4), a major postoperative complication (OR = 5.7; 95% CI, 3.2-10.2), postoperative pulmonary embolism (OR = 12.2; 95% CI, 1.9-78.4), no postoperative blood transfusion (OR = 3.3; 95% CI, 1.7-6.2), surgical site infection (OR = 5.3; 95% CI, 2.9-10.0), and post-hepatectomy hyperbilirubinemia (OR = 1.1; 95% CI, 1.1-1.2). A scoring system based on these risk factors accurately predicted readmission in the validation cohort. A score of >20 points had a positive predictive value of 30.8% and negative predictive value of 95.6%, and a score >50 had a positive predictive value of 50.9% and negative predictive value of 87.7%. This risk score accurately stratifies readmission risk.The risk of hospital readmission within 90 days after major hepatectomy is high and is reliably predicted with a novel scoring system.