Readmission after pancreaticoduodenectomy: Birmingham score validation. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Palen, Anaïs; Garnier, Jonathan; Ewald, Jacques; Delpero, Jean-Robert; Turrini, Olivier
• Is Part Of: HPB. Volume 25:Issue 2(2023)
• Page Start: 172
• Page End: 178
• Publication Date: 2023-02
• Subjects: Pancreaticoduodenectomy -- Readmission -- Birmingham risk score; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2022.08.002
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: The Birmingham score predicts the risk of hospital readmission after pancreaticoduodenectomy (PD). This study aimed to validate the risk score in a different healthcare cohort. Methods: From 2017 to 2021, 301 patients underwent PD. The Birmingham score was applied to 276 patients. Postoperative deceased patients (n = 7) or those requiring a completion of pancreatectomy (n = 18) were excluded. Results: Forty-seven (17%) patients were readmitted after a median delay of 9 (range 1–49) days and stayed for 5 (range 1–27) days; 4 (8.5%) died during the hospital stay. The leading cause of readmission was a septic condition (53%), mostly resolved by medical treatment (77%). A multivariate analysis identified the occurrence of a clinically relevant postoperative pancreatic fistula, the score criteria, and the score itself as independent factors favouring readmission. Readmission rates in patients with low [n = 97 (35%)], intermediate [n = 98 (36%)], and high [n = 81 (29%)] scores were 5%, 17%, and 31%, respectively ( P < 0.01). Conclusion: This study confirmed the relevance and robustness of the Birmingham risk score. Patients with a high risk of readmission after PD, identified based on the score, were discharged to a partnership medical centre close to the pancreatic centre to plan readmission and avoid futile unplanned hospitalisation.