gms | German Medical Science

Introduction: There is new data concerning the impact of readmissions after pancreatic resections, we wanted to assess the situation at our department.

Material and methods: From 08/03 to 08/13 there were n=356 pancreatic resections. Patient details and all complications, reinterventions and reoperations were documented in a prospectively maintaned database. For all patients a query of the hospital billing database (SAP Inc.) was made and all readmissions within 30 days from the operation were identified. By review of patient charts the underlying cause and therapeutic consequence of readmissions was analysed. For univariate risk factor analysis of categorical variables we performed a chi square test. For numerical data after testing for normal distribution t- or Mann Whitney U Tests were performed accordingly.

Results: There were 7,9% (28/356) readmissions at a median of 22 days (10-30) after operation and a median of 4 days (1-19) after discharge respectively. Most readmissions occurred after pancreatic cancer resections (39,3%). Readmitted patients median age was 65 years. In 89% (25/28) there were complications, three patients were scheduled for elective procedures (PET CT, Port Implant, Restaging). There were n=6 intraabdominal collections that were all drained interventionally and n=5 pancreatic fistulas (n=2 persisting fistulas, n=3 late fistulas that were not detected after the index operation). The two late fistulas were already surgically drained since the index operation, two of the three late fistulas were interventionally drained. The only patient who was reoperated died because of multi organ failure due to bleeding because of not detected late pancreatic fistula. There were no other deaths. All other complications leading to readmission were only grade I-IIa according to Deoliveira. Diagnosis (p=0,8432) and age (p1=0,409 p2=0,8181) were no significant risk factors for readmission.

Conclusion: Most readmissions occur after mild complications, interventional drainage of all postoperative collections is mandatory otherwise they harbour a significant mortality risk.