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Evaluating readmissions following laparoscopic cholecystectomy in the state of New York
Maria S Altieri1, Jie Yang2, Xiaoyue Zhang3
1Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA. Altieri.m@gmail.com.
Insights
Hospital readmissions after laparoscopic cholecystectomy (LC) are low but mostly unplanned. Identifying at-risk groups can help prevent these unplanned readmissions, improving patient outcomes and reducing healthcare costs.
Area of Science:
- Surgical Outcomes
- Healthcare Management
- Gastrointestinal Surgery
Background:
- Hospital readmissions represent a significant healthcare burden and cost.
- Existing studies on laparoscopic cholecystectomy (LC) readmissions are often single-center and may underestimate incidence.
Purpose of the Study:
- To examine the rate and causes of hospital readmissions following LC.
- To identify risk factors for unplanned readmissions using a large longitudinal database.
Main Methods:
- Utilized the New York SPARCS database (2000-2016) for adult patients undergoing LC for benign biliary disease.
- Compared planned versus unplanned readmission rates and employed multivariable logistic regression to identify risk factors for unplanned readmissions.
Main Results:
- A total of 591,627 patients underwent LC, with an overall 30-day readmission rate of 4.94% and an unplanned rate of 4.58%.
- Risk factors for unplanned readmissions included older/younger age, Medicaid/Medicare insurance, Black race, comorbidities, postoperative complications, and longer initial hospital stay. Female patients had lower unplanned readmission rates.
Conclusions:
- Readmission rates after LC are low, but the majority are unplanned.
- Complications of the procedure or medical care were the primary drivers of unplanned readmissions.
- Identifying specific risk groups can facilitate the prevention of unplanned readmissions.
Introduction:
Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database.
Methods:
The New York SPARCS database was used to identify all adult patients undergoing laparoscopic cholecystectomy for benign biliary disease between 2000 and 2016. Due to the presence of a unique identifier, patients with readmission to any New York hospital were evaluated. Planned versus unplanned readmission rates were compared. Following univariate analysis, multivariable logistic regression model was used to identify risk factors for unplanned readmissions after accounting for baseline characteristics, comorbidities and complications.
Results:
There were 591,627 patients who underwent LC during the studied time period. Overall 30-day readmission rate was 4.94% (n = 29,245) and unplanned 30-days readmission rate was 4.58% (n = 27,084). Female patients were less likely to have 30-day unplanned readmissions. Patients with age older than 65 or younger than 29 were more likely to have 30-day unplanned readmissions compared to patients with age 30-44 or 45-64. Insurance status was also significant, as patients with Medicaid/Medicare were more likely to have unplanned readmissions compared to commercial insurance. In addition, variables such as Black race, presence of any comorbidity, postoperative complication, and prolonged initial hospital length of stay were associated with subsequent readmission.
Conclusion:
This data show that readmissions rates following LC are relatively low; however, majority of readmissions are unplanned. Most common reason for unplanned readmissions was associated with complications of the procedure or medical care. By identifying certain risk groups, unplanned readmissions may be prevented.
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