Treatment outcomes, 30-day readmission and healthcare resource utilization after pancreatoduodenectomy for pancreatic malignancies

Background We sought to determine treatment outcomes after pancreatoduodenectomy for pancreatic head and uncinate process malignancy and its impact on mortality, morbidity, and resource utilization. Methods This was a retrospective cohort study using the 2014 Nationwide Readmissions Database. Discharges were included if they had an ICD-9 CM procedure code for pancreatoduodenectomy and any code for malignancy of the pancreas head and uncinate process. Independent predictors of readmission were identified using multivariable Cox regression analysis. Results A total of 4,445 patients were included. The surgical complication rate was 17.3%, and in-hospital mortality rate was 3%. The 30-day readmission rate was 19.7% with an in-hospital mortality rate of 3.9%. The most common reason for readmission was postoperative infection. The mean length of stay during readmission was 6.50 days, while the mean total hospitalization costs and charges were $15,589 and $52,922, respectively. The number of hospital days associated with readmission was 5,548, with an in-hospital economic burden of $12.9 million (costs) and $43.7 million (charges). Hospital volume and discharge disposition were independent predictors of 30-day readmission. Conclusions Pancreatoduodenectomy for pancreatic malignancies is still associated with significant morbidity, mortality and 30-day readmission. Reducing readmission can impact mortality, quality of life, and healthcare economic burden in this setting.