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Predictors of 30 Day Readmission Following Percutaneous Cholecystostomy
Matthew M Fleming1, Fangfang Liu2, Jiajun Luo3
1Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
Insights
High-risk patients undergoing percutaneous cholecystostomy (PC) face significant readmission rates. Factors like alcohol use, diabetes, heart failure, depression, and cancer increase this risk, necessitating improved care coordination.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Health Services Research
Background:
- High-risk patients undergoing cholecystectomy face elevated morbidity and mortality.
- Percutaneous cholecystostomy (PC) is an option for acute cholecystitis in this population.
- Risk factors for readmission after PC are not well understood.
Purpose of the Study:
- To identify risk factors associated with 30-day readmission following percutaneous cholecystostomy (PC).
Main Methods:
- Retrospective cohort study using the National Readmission Database (2013-2014).
- Identified patients who underwent PC.
- Multivariate logistic regression analyzed predictors of 30-day readmission.
Main Results:
- 20.7% of 3,368 patients were readmitted within 30 days.
- Alcohol use, uncomplicated diabetes, congestive heart failure, depression, and metastatic cancer were significant risk factors.
- Readmitted patients had longer index hospital stays (>8 days).
Conclusions:
- A substantial number of patients are readmitted post-PC.
- Enhanced care coordination during the initial admission is crucial.
- Further research is needed on patient selection for upfront cholecystectomy.
Background:
High-risk patients undergoing cholecystectomy may experience increased morbidity and mortality. Percutaneous cholecystostomy (PC) has been utilized as a treatment option for acute cholecystitis in this cohort. Little is known about risk factors for readmission following PC.
Materials And Methods:
Patients who had PC from 2013 to 2014 were identified from the National Readmission Database by the Healthcare Cost and Utilization Project. A 30-d readmission was defined as a subsequent admission within 30 d following the first admission discharge date. Multivariate logistic regression models using stepwise selection were employed to select significant predictive variables for subsequent readmission.
Results:
Three thousand three hundred sixty-eight patients were identified with 698 (20.7%) readmissions during the study period. Of the readmitted patients, 79 (2.35%) had two readmissions and six patients (0.19%) had three or more readmissions within 30 d of their index procedure. In addition, alcohol use (odds ratios [OR] 1.58, confidence intervals [CI] 1.10-2.29), uncomplicated diabetes (OR 1.21, CI 1.00-1.47), congestive heart failure (OR 1.28, CI 1.03-2.44), depression (OR 1.42, CI 1.08-1.86), and metastatic cancer (OR 1.65, CI 1.11-2.46) were significantly correlated with risk for readmission. Readmitted patients had longer hospital stays (OR 1.38 CI 1.09-1.74, length of stay >8 d).
Conclusions:
A significant proportion of patients are readmitted within 30 d following PC. These patients may benefit from increase care coordination starting at their index admission. Studies are needed to determine patient selection for upfront cholecystectomy.
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