Highlights
- •LACE + readmission index fails to accurately predict readmission in an HPB patient population.
- •Hepatopancreatobiliary readmission risk score independently predicts readmission.
- •Use of clinically relevant readmission risk calculators is warranted in postoperative patients.
Abstract
Background
This study aims to compare the LACE + readmission index to a novel hepatopancreatobiliary
readmission risk score (HRRS) in predicting post-operative hepatopancreatobiliary
(HPB) cancer patient readmissions.
Methods
A retrospective review of 104 postoperative HPB cancer patients from January 2017
to July of 2019 was performed. Univariable and multivariable analyses were utilized.
Results
The LACE + index did not predict 30-day (OR 1.01, 95% CI, 0.97–1.05, p = 0.81, c-statistic = 0.52)
or 90-day (OR 1.02, 95% CI, 0.98–1.05, p = 0.43) readmission. Patients readmitted
within 30 days had significantly increased HRRS scores compared to those who were
not (0 vs 34, p < 0.001). A single unit increase in HRRS corresponded to a 6.5% increased
risk of readmission; (OR 1.065, 95% CI, 1.038–1.094, p < 0.0001). HRRS independently
predicted 30-day (OR 1.07, 95% CI, 1.04–1.11, p < 0.0001) and 90-day postoperative
readmission (OR 1.05, 95% CI 1.03–1.08, p < 0.0001).
Conclusions
HRRS better predicts postoperative readmissions for HPB surgical patients compared
to LACE+. Accurate assessment of postoperative readmission must include readmission
scores focused on clinically relevant perioperative parameters.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hospital readmissions and the Affordable Care Act: paying for coordinated quality care.Jama. 2011; 306: 1794-1795
- Hospital readmission as an accountability measure.J Am Med Assoc. 2011; 305: 504-505
- Index versus non-index readmission after hepato-pancreato-biliary surgery: where do patients go to Be readmitted?.J Gastrointest Surg. 2019; 23: 702-711
- Readmissions reduction Program (HRRP).([Available from:)
- Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.Ann Surg. 2005; 242: 326-343
- Assessing readmission after general, vascular, and thoracic surgery using.ACS-NSQIP. Annals of surgery. 2013; 258: 430-439
- Unexpected readmissions after major cancer surgery: an evaluation of readmissions as a quality-of-care indicator.Surg Oncol Clin. 2012; 21 (viii): 397-405
- Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community.CMAJ (Can Med Assoc J). 2010; 182: 551-557
- LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data.Open Med : a peer-reviewed, independent, open-access journal. 2012; 6: e80-e90
- Performance of the LACE index to predict 30-day hospital readmissions in patients with chronic obstructive pulmonary disease.Clin Epidemiol. 2018; 10: 51
- Using the LACE index to predict hospital readmissions in congestive heart failure patients.BMC Cardiovasc Disord. 2014; 14: 97
- LACE+ index as predictor of 30-day readmission in brain tumor population.World Neurosurg. 2019; 127: e443-e448
- The LACE+ index fails to predict 30–90 day readmission for supratentorial craniotomy patients: a retrospective series of 238 surgical procedures.Clin Neurol Neurosurg. 2019; 182: 79-83
- Evaluating the predictive strength of the LACE index in identifying patients at high risk of hospital readmission following an inpatient episode: a retrospective cohort study.BMJ open. 2017; 7e016921
- Simplified risk prediction indices do not accurately predict 30-day death or readmission after discharge following colorectal surgery.Surgery. 2019; 165: 882-888
- Utility of the LACE scoring System in predicting readmission following Tracheotomy and Laryngectomy. Ear.Nose & Throat Journal. 2019; 98: 220-222
- Readmission rates after abdominal surgery: the role of surgeon, primary caregiver, home health, and subacute rehab.Ann Surg. 2011; 254: 591-597
- Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients.Ann Surg. 2012; 256: 529-537
- Examining reoperation and readmission after hepatic surgery.J Am Coll Surg. 2013; 216: 915-923
- Readmission incidence and associated factors after a hepatic resection at a major hepato‐pancreatico‐biliary academic centre.HPB. 2014; 16: 972-978
- Factors predictive of readmission after hepatic resection for hepatocellular carcinoma.Surgery. 2014; 156: 1039-1048
- Risk stratification for readmission after major hepatectomy: development of a readmission risk score.J Am Coll Surg. 2015; 220: 640-648
- LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data.Open Med. 2012; 6: e80
- Hospital volume and patient outcomes in hepato-pancreatico-biliary surgery: is assessing differences in mortality enough?.J Gastrointest Surg. 2014; 18: 2105-2115
- Perioperative complications and the cost of rescue or failure to rescue in hepato-pancreato-biliary surgery.HPB. 2018; 20: 854-864
- Patient readmission and mortality after surgery for hepato-pancreato-biliary malignancies.J Am Coll Surg. 2012; 215: 607-615
- The timing of complications impacts risk of readmission after hepatopancreatobiliary surgery.Surgery. 2014; 155: 945-953
- Readmission following pancreatectomy: what can be improved?.HPB. 2013; 15: 703-708
- Utility of the LACE scoring system in predicting readmission following tracheotomy and Laryngectomy.Ear Nose Throat J. 2019; 98: 220-222
- The LACE+ index fails to predict 30-90 day readmission for supratentorial craniotomy patients: a retrospective series of 238 surgical procedures.Clin Neurol Neurosurg. 2019; 182: 79-83
- Validation of the LACE readmission and mortality prediction model in a large surgical cohort: Comparison of performance at preoperative assessment and discharge time points.J Clin Anesth. 2019; 58: 22-26
- Multiple complications and short length of stay are associated with postoperative readmissions.Am J Surg. 2014; 207: 449-456
- Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis.Ann Surg. 2010; 251: 91-100
- Modified frailty index is an effective risk assessment tool in primary total knee arthroplasty.J Arthroplasty. 2017; 32: S177-S182
Article info
Publication history
Published online: September 30, 2021
Accepted:
September 29,
2021
Received in revised form:
September 19,
2021
Received:
September 6,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
