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    Research Letter
    Pacific Coast Surgical Association
    January 2019

    Association of Hospital Length of Stay and Complications With Readmission After Open Pancreaticoduodenectomy

    Author Affiliations
    • 1Medical student, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
    • 2Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles
    • 3Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles
    JAMA Surg. 2019;154(1):88-90. doi:10.1001/jamasurg.2018.3213

    New reimbursement policies under the Affordable Care Act Hospital Readmission Reduction Program place hospitals under increasing pressure to reduce costs by accelerating care and discharge after surgery.1 However, premature discharge may be associated with subsequent complications and readmission.2 We used a national surgical database to investigate possible predictive factors for and the association of postsurgery hospitalization duration with readmission after open pancreaticoduodenectomy.

    The American College of Surgeons National Quality Improvement Program and targeted hepatopancreaticobiliary databases were queried to identify patients who underwent open pancreaticoduodenectomy (Current Procedural Terminology codes 48150 and 48153) between January 1, 2014, and December 31, 2015. Patients with a hospital length of stay (LOS) longer than 14 days, who constituted 1052 (16.9%) of the original cohort of 6226, were excluded to overcome underestimation of readmission rates caused by immortal time bias in the database’s documentation of this variable.3 Data were collected and analyzed between August 1, 2017, and April 28, 2018. The University of California, Los Angeles Investigational Review Board deemed this study exempt from review because the data were obtained from a publicly available deidentified database organized by the American College of Surgeons.