A Novel Risk Scoring System Reliably Predicts Readmission after Pancreatectomy - 23/03/15

Doi : 10.1016/j.jamcollsurg.2014.12.038

Vicente Valero, MD ^a, Joshua C. Grimm, MD ^a, Arman Kilic, MD ^a, Russell L. Lewis, BS ^b, Jeffrey J. Tosoian, MD, MPH ^a, Jin He, MD ^a, James F. Griffin, MD ^a, John L. Cameron, MD ^a, Matthew J. Weiss, MD ^a, Charles M. Vollmer, MD ^b, Christopher L. Wolfgang, MD, PhD ^a,^⁎
The Pancreas Readmission Assessment Group Study
^a Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
^b Department of Surgery, The University of Pennsylvania School of Medicine, Philadelphia, PA

^∗Correspondence address: Christopher L Wolfgang, MD, PhD, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N Wolfe St, 685 Blalock, Baltimore, MD 21287.

Abstract

Background

Postoperative readmissions have been proposed by Medicare as a quality metric and can impact provider reimbursement. Because readmission after pancreatectomy is common, we sought to identify factors associated with readmission to establish a predictive risk scoring system.

Study Design

A retrospective analysis of 2,360 pancreatectomies performed at 9 high-volume pancreatic centers between 2005 and 2011 was performed. Forty-five factors strongly associated with readmission were identified. To derive and validate a risk scoring system, the population was randomly divided into 2 cohorts in a 4:1 fashion. A multivariable logistic regression model was constructed and scores were assigned based on the relative odds ratio (OR) of each independent predictor. A composite Readmission after Pancreatectomy (RAP) score was generated and then stratified to create risk groups.

Results

Overall, 464 (19.7%) patients were readmitted within 90 days. Eight pre- and postoperative factors, including earlier MI (OR = 2.03), American Society of Anesthesiologists class ≥3 (OR = 1.34), dementia (OR = 6.22), hemorrhage (OR = 1.81), delayed gastric emptying (OR = 1.78), surgical site infection (OR = 3.31), sepsis (OR = 3.10), and short length of stay (OR = 1.51) were independently predictive of readmission. The 32-point RAP score generated from the derivation cohort was highly predictive of readmission in the validation cohort (area under the receiver operating curve = 0.72). The low-risk (0 to 3), intermediate-risk (4 to 7), and high-risk (>7) groups correlated with 11.7%, 17.5%, and 45.4% observed readmission rates, respectively (p < 0.001).

Conclusions

The RAP score is a novel and clinically useful risk scoring system for readmission after pancreatectomy. Identification of patients with increased risk of readmission using the RAP score will allow efficient resource allocation aimed to attenuate readmission rates. It also has potential to serve as a new metric for comparative research and quality assessment.

Le texte complet de cet article est disponible en PDF.

Abbreviation and Acronyms : ACS, ASA, CCI, CMS, DGE, LOS, OR, PMI, RAP, SSI