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Fast-Track Pancreaticoduodenectomy: Factors Associated with Early Discharge

  • David A. MahviEmail author
  • Linda M. Pak
  • Sourav K. Bose
  • Richard D. Urman
  • Jason S. Gold
  • Edward E. Whang
Original Scientific Report
  • 42 Downloads

Abstract

Background

Pancreaticoduodenectomy is a complex surgery frequently associated with prolonged hospitalizations. However, there are a subset of patients discharged within 5 days from surgery; the preoperative and intraoperative characteristics of this subset are unknown.

Methods

The NSQIP Targeted Pancreatectomy Dataset was used from 2014 to 2016. Patients who died within 30 days were excluded. A total of 10,741 patients undergoing pancreaticoduodenectomy were identified. Univariable and multivariable logistic regression analyses were performed for preoperative and intraoperative ACS-NSQIP variables to identify predictors of early discharge. Early discharge was defined as discharge 3–5 days after surgery.

Results

A total of 1105 patients (10.3%) were discharged within 5 days following pancreaticoduodenectomy. On multivariable analysis, preoperative factors associated with early discharge included younger age (OR 0.988, p < 0.001), non-obesity (OR 0.737, p = 0.001), those receiving neoadjuvant chemotherapy (OR 1.424, p < 0.001), and lack of COPD (OR 0.489, p = 0.005) or hypertension (OR 0.805, p = 0.007). Intraoperative factors associated with early discharge on multivariable analysis were shorter operation duration (OR 0.999, p = 0.002), minimally invasive surgery (OR 3.537, p < 0.001), and hard pancreatic texture (OR 1.480, p < 0.001). Intraoperative factors associated with non-early discharge were epidural placement (OR 0.485, p < 0.001), drain placement (OR 0.308, p < 0.001), and jejunostomy tube placement (OR 0.278, p < 0.001). Patients discharged within 5 days had a 14.7% readmission rate compared to 17.0% for later discharges (p = 0.047).

Conclusions

Multiple preoperative and intraoperative factors, including some that are potentially modifiable, were significantly associated with early discharge after pancreaticoduodenectomy. Patients with these characteristics may benefit from enhanced recovery after surgery programs and expedited disposition planning postoperatively.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s Hospital/Harvard Medical SchoolBostonUSA
  2. 2.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s Hospital/Harvard Medical SchoolBostonUSA
  3. 3.Department of SurgeryVA Boston Healthcare SystemWest RoxburyUSA

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