Journal Article

Do Weekend Discharges Impact Readmission Rate in Patients Undergoing Pancreatic Surgery?

Zyromski, Nicholas J., Nakeeb, Attila, Muraru, Rodica I., Roch, Alexandra, Nguyen, Trang K., Schmidt, C. Max, Kim, Rachel C., Schick, Stephanie E., Ceppa, Eugene P., House, Michael G.

2023

Overview

Weekend readmissions have been previously associated with increased mortality after pancreatic resection, but the effect of weekend discharge is less understood. In this study, we aim to determine the impact of weekend discharges on 30-day readmission rate after pancreatic surgery. All patients who underwent pancreatic surgery at a single, high-volume institution between 2013 and 2021 were retrospectively reviewed from a targeted, institutional ACS-NSQIP database. Patients who died prior to discharge were excluded. Multivariable logistic regression was used to assess the relationship between readmission and weekend discharge. Out of 2042 patients who underwent pancreatectomy, 418 patients (20.5%) were discharged on the weekend. Weekend discharge was associated with fewer Whipple surgeries, fewer open surgical approaches, and shorter operative time. Patients discharged on the weekend were also less likely to have had postoperative complications such as delayed gastric emptying (DGE) (6.7% vs 12.6%, p < 0.01) and were more frequently discharged to home (91.1% vs. 85.3%, p < 0.01). Thirty-day readmission rate was almost identical between groups (14.8% vs 14.8%, p = 0.997). On multivariable analysis, 30-day readmission was independently associated with DGE (OR (95% CI): 3.48 (2.31–5.23), p < 0.01), postoperative pancreatic fistula (3.36 (2.34–4.83), p < 0.01), myocardial infarction, and perioperative blood transfusion, but not weekend discharge (1.02 (0.72–1.43), p = 0.93). Readmission rate also did not differ significantly when including Friday discharges in the weekend group (15.2% vs 14.6%, p = 0.72). With careful clinical decision making, patients may safely be discharged on the weekend after pancreatic surgery without increasing 30-day readmission rate.

• Publisher: Elsevier Inc,Springer US,Springer Nature B.V
• Subject: Blood transfusions / Distal Pancreatectomy / Expected values / Fistula / Gastroenterology / Gastrointestinal surgery / Hospitals / Humans / Medicine / Medicine & Public Health / Mortality / Original Article / Pancreatectomy / Pancreatectomy - adverse effects / Pancreatoduodenectomy / Patient Discharge / Patient Readmission / Patients / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Readmission / Regression analysis / Retrospective Studies / Risk Factors / Statistical analysis / Surgery / Weekend Discharge / Weekend Effect / Whipple