Format

Send to

Choose Destination
J Surg Res. 2019 Jan;233:1-7. doi: 10.1016/j.jss.2018.07.006. Epub 2018 Jul 26.

Predictors of 30 Day Readmission Following Percutaneous Cholecystostomy.

Author information

1
Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
2
Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale School of Medicine, New Haven, Connecticut; Beijing 302 Hospital, Beijing, China.
3
Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale School of Medicine, New Haven, Connecticut.
4
Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale School of Medicine, New Haven, Connecticut; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.
5
Department of Surgery, Yale School of Medicine, New Haven, Connecticut. Electronic address: kevin.pei@yale.edu.

Abstract

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.

KEYWORDS:

Acute calculous cholecystitis; Emergency surgery; Health services research; Nonoperative management; Percutaneous cholecystostomy

PMID:
30502233
DOI:
10.1016/j.jss.2018.07.006

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center