Key result
A novel 32-point Readmission after Pancreatectomy (RAP) score successfully stratified patients into low, intermediate, and high-risk groups with 90-day readmission rates of 11.7%, 17.5%, and 45.4%.
Cohort (n=2,360)
Yes
Effect estimate: AUC 0.72
p-value: p=< 0.001
The RAP score is a novel, validated 32-point risk scoring system that reliably predicts 90-day readmission after pancreatectomy.
May support targeted monitoring in high-risk pancreatectomy patients; leaves open prospective validation before clinical adoption.
BACKGROUND: Postoperative readmissions have been proposed by Medicare as a quality metric and can impact provider reimbursement. Because readmission after pancreatectomy is common, we sought to identify factors associated with readmission to establish a predictive risk scoring system. STUDY DESIGN: A retrospective analysis of 2,360 pancreatectomies performed at 9 high-volume pancreatic centers between 2005 and 2011 was performed. Forty-five factors strongly associated with readmission were identified. To derive and validate a risk scoring system, the population was randomly divided into 2 cohorts in a 4:1 fashion. A multivariable logistic regression model was constructed and scores were assigned based on the relative odds ratio (OR) of each independent predictor. A composite Readmission after Pancreatectomy (RAP) score was generated and then stratified to create risk groups. RESULTS: Overall, 464 (19.7%) patients were readmitted within 90 days. Eight pre- and postoperative factors, including earlier MI (OR = 2.03), American Society of Anesthesiologists class ≥ 3 (OR = 1.34), dementia (OR = 6.22), hemorrhage (OR = 1.81), delayed gastric emptying (OR = 1.78), surgical site infection (OR = 3.31), sepsis (OR = 3.10), and short length of stay (OR = 1.51) were independently predictive of readmission. The 32-point RAP score generated from the derivation cohort was highly predictive of readmission in the validation cohort (area under the receiver operating curve = 0.72). The low-risk (0 to 3), intermediate-risk (4 to 7), and high-risk (>7) groups correlated with 11.7%, 17.5%, and 45.4% observed readmission rates, respectively (p < 0.001). CONCLUSIONS: The RAP score is a novel and clinically useful risk scoring system for readmission after pancreatectomy. Identification of patients with increased risk of readmission using the RAP score will allow efficient resource allocation aimed to attenuate readmission rates. It also has potential to serve as a new metric for comparative research and quality assessment.
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Valero et al. (2015) conducted a cohort in Pancreatectomy (n=2,360). Readmission after Pancreatectomy (RAP) score was evaluated on Readmission within 90 days (AUC 0.72, p=< 0.001). A novel 32-point Readmission after Pancreatectomy (RAP) score successfully stratified patients into low, intermediate, and high-risk groups with 90-day readmission rates of 11.7%, 17.5%, and 45.4%.
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