The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy
Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation....
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Pecorelli, Nicolò [verfasserIn] Guarneri, Giovanni [verfasserIn] Alagol, Kemal [verfasserIn] Mazza, Michele [verfasserIn] Quattromani, Roberto [verfasserIn] Partelli, Stefano [verfasserIn] Crippa, Stefano [verfasserIn] Castoldi, Renato [verfasserIn] Balzano, Gianpaolo [verfasserIn] Falconi, Massimo [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2020 |
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| Schlagwörter: |
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| Anmerkung: |
© Springer Science+Business Media, LLC, part of Springer Nature 2020 |
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| Übergeordnetes Werk: |
Enthalten in: Surgical endoscopy and other interventional techniques - New York, NY : Springer, 1987, 35(2020), 10 vom: 06. Okt., Seite 5740-5751 |
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| Übergeordnetes Werk: |
volume:35 ; year:2020 ; number:10 ; day:06 ; month:10 ; pages:5740-5751 |
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| DOI / URN: |
10.1007/s00464-020-08051-z |
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| Katalog-ID: |
SPR045059586 |
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| 245 | 1 | 4 | |a The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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| 520 | |a Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. | ||
| 650 | 4 | |a Pancreatic neoplasms |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Distal pancreatectomy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Laparoscopy |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Readmissions |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Emergency department |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Postoperative recovery |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Guarneri, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Alagol, Kemal |e verfasserin |4 aut | |
| 700 | 1 | |a Mazza, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Quattromani, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Partelli, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Crippa, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Castoldi, Renato |e verfasserin |4 aut | |
| 700 | 1 | |a Balzano, Gianpaolo |e verfasserin |4 aut | |
| 700 | 1 | |a Falconi, Massimo |e verfasserin |4 aut | |
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10.1007/s00464-020-08051-z doi (DE-627)SPR045059586 (SPR)s00464-020-08051-z-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Pecorelli, Nicolò verfasserin aut The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer Science+Business Media, LLC, part of Springer Nature 2020 Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 Guarneri, Giovanni verfasserin aut Alagol, Kemal verfasserin aut Mazza, Michele verfasserin aut Quattromani, Roberto verfasserin aut Partelli, Stefano verfasserin aut Crippa, Stefano verfasserin aut Castoldi, Renato verfasserin aut Balzano, Gianpaolo verfasserin aut Falconi, Massimo verfasserin aut Enthalten in Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 35(2020), 10 vom: 06. Okt., Seite 5740-5751 (DE-627)254909620 (DE-600)1463171-4 1432-2218 nnns volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 https://dx.doi.org/10.1007/s00464-020-08051-z lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.87 ASE AR 35 2020 10 06 10 5740-5751 |
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10.1007/s00464-020-08051-z doi (DE-627)SPR045059586 (SPR)s00464-020-08051-z-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Pecorelli, Nicolò verfasserin aut The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer Science+Business Media, LLC, part of Springer Nature 2020 Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 Guarneri, Giovanni verfasserin aut Alagol, Kemal verfasserin aut Mazza, Michele verfasserin aut Quattromani, Roberto verfasserin aut Partelli, Stefano verfasserin aut Crippa, Stefano verfasserin aut Castoldi, Renato verfasserin aut Balzano, Gianpaolo verfasserin aut Falconi, Massimo verfasserin aut Enthalten in Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 35(2020), 10 vom: 06. Okt., Seite 5740-5751 (DE-627)254909620 (DE-600)1463171-4 1432-2218 nnns volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 https://dx.doi.org/10.1007/s00464-020-08051-z lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.87 ASE AR 35 2020 10 06 10 5740-5751 |
| allfields_unstemmed |
10.1007/s00464-020-08051-z doi (DE-627)SPR045059586 (SPR)s00464-020-08051-z-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Pecorelli, Nicolò verfasserin aut The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer Science+Business Media, LLC, part of Springer Nature 2020 Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 Guarneri, Giovanni verfasserin aut Alagol, Kemal verfasserin aut Mazza, Michele verfasserin aut Quattromani, Roberto verfasserin aut Partelli, Stefano verfasserin aut Crippa, Stefano verfasserin aut Castoldi, Renato verfasserin aut Balzano, Gianpaolo verfasserin aut Falconi, Massimo verfasserin aut Enthalten in Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 35(2020), 10 vom: 06. Okt., Seite 5740-5751 (DE-627)254909620 (DE-600)1463171-4 1432-2218 nnns volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 https://dx.doi.org/10.1007/s00464-020-08051-z lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.87 ASE AR 35 2020 10 06 10 5740-5751 |
| allfieldsGer |
10.1007/s00464-020-08051-z doi (DE-627)SPR045059586 (SPR)s00464-020-08051-z-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Pecorelli, Nicolò verfasserin aut The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer Science+Business Media, LLC, part of Springer Nature 2020 Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 Guarneri, Giovanni verfasserin aut Alagol, Kemal verfasserin aut Mazza, Michele verfasserin aut Quattromani, Roberto verfasserin aut Partelli, Stefano verfasserin aut Crippa, Stefano verfasserin aut Castoldi, Renato verfasserin aut Balzano, Gianpaolo verfasserin aut Falconi, Massimo verfasserin aut Enthalten in Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 35(2020), 10 vom: 06. Okt., Seite 5740-5751 (DE-627)254909620 (DE-600)1463171-4 1432-2218 nnns volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 https://dx.doi.org/10.1007/s00464-020-08051-z lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.87 ASE AR 35 2020 10 06 10 5740-5751 |
| allfieldsSound |
10.1007/s00464-020-08051-z doi (DE-627)SPR045059586 (SPR)s00464-020-08051-z-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Pecorelli, Nicolò verfasserin aut The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Springer Science+Business Media, LLC, part of Springer Nature 2020 Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 Guarneri, Giovanni verfasserin aut Alagol, Kemal verfasserin aut Mazza, Michele verfasserin aut Quattromani, Roberto verfasserin aut Partelli, Stefano verfasserin aut Crippa, Stefano verfasserin aut Castoldi, Renato verfasserin aut Balzano, Gianpaolo verfasserin aut Falconi, Massimo verfasserin aut Enthalten in Surgical endoscopy and other interventional techniques New York, NY : Springer, 1987 35(2020), 10 vom: 06. Okt., Seite 5740-5751 (DE-627)254909620 (DE-600)1463171-4 1432-2218 nnns volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 https://dx.doi.org/10.1007/s00464-020-08051-z lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_32 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_101 GBV_ILN_105 GBV_ILN_110 GBV_ILN_120 GBV_ILN_138 GBV_ILN_150 GBV_ILN_151 GBV_ILN_152 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_187 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_250 GBV_ILN_267 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_636 GBV_ILN_702 GBV_ILN_711 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2004 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2031 GBV_ILN_2034 GBV_ILN_2037 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2065 GBV_ILN_2068 GBV_ILN_2093 GBV_ILN_2106 GBV_ILN_2107 GBV_ILN_2108 GBV_ILN_2110 GBV_ILN_2113 GBV_ILN_2118 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2144 GBV_ILN_2147 GBV_ILN_2153 GBV_ILN_2188 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2446 GBV_ILN_2470 GBV_ILN_2472 GBV_ILN_2507 GBV_ILN_2522 GBV_ILN_2548 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4046 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4246 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4326 GBV_ILN_4328 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4335 GBV_ILN_4336 GBV_ILN_4338 GBV_ILN_4393 GBV_ILN_4700 44.87 ASE AR 35 2020 10 06 10 5740-5751 |
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English |
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Enthalten in Surgical endoscopy and other interventional techniques 35(2020), 10 vom: 06. Okt., Seite 5740-5751 volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 |
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Enthalten in Surgical endoscopy and other interventional techniques 35(2020), 10 vom: 06. Okt., Seite 5740-5751 volume:35 year:2020 number:10 day:06 month:10 pages:5740-5751 |
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Pancreatic neoplasms Distal pancreatectomy Laparoscopy Readmissions Emergency department Postoperative recovery |
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Surgical endoscopy and other interventional techniques |
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Pecorelli, Nicolò @@aut@@ Guarneri, Giovanni @@aut@@ Alagol, Kemal @@aut@@ Mazza, Michele @@aut@@ Quattromani, Roberto @@aut@@ Partelli, Stefano @@aut@@ Crippa, Stefano @@aut@@ Castoldi, Renato @@aut@@ Balzano, Gianpaolo @@aut@@ Falconi, Massimo @@aut@@ |
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However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. 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Pecorelli, Nicolò |
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Pecorelli, Nicolò ddc 610 bkl 44.87 misc Pancreatic neoplasms misc Distal pancreatectomy misc Laparoscopy misc Readmissions misc Emergency department misc Postoperative recovery The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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610 ASE 44.87 bkl The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy Pancreatic neoplasms (dpeaa)DE-He213 Distal pancreatectomy (dpeaa)DE-He213 Laparoscopy (dpeaa)DE-He213 Readmissions (dpeaa)DE-He213 Emergency department (dpeaa)DE-He213 Postoperative recovery (dpeaa)DE-He213 |
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The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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Surgical endoscopy and other interventional techniques |
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Pecorelli, Nicolò Guarneri, Giovanni Alagol, Kemal Mazza, Michele Quattromani, Roberto Partelli, Stefano Crippa, Stefano Castoldi, Renato Balzano, Gianpaolo Falconi, Massimo |
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impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. © Springer Science+Business Media, LLC, part of Springer Nature 2020 |
| abstractGer |
Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. © Springer Science+Business Media, LLC, part of Springer Nature 2020 |
| abstract_unstemmed |
Background A recent RCT showed similar postoperative outcomes and a reduced time to functional recovery in patients undergoing minimally invasive distal pancreatectomy (DP) compared to open approach. However, it reported very-high post-discharge readmission rates, calling for further investigation. The aim of our study was to evaluate the extent to which minimally invasive surgery impacts on postoperative readmissions following DP. Methods Clinical data for patients undergoing DP between 2011 and 2018 were reviewed. Primary outcome was hospital readmission at 90 days after surgery. Secondary outcomes included post-discharge emergency department (ED) visits and time to functional recovery. Regression analyses were performed to evaluate the impact of the laparoscopic approach and other perioperative factors. Results Overall, 376 consecutive patients underwent DP during the study period. Laparoscopy was successfully performed in 219 (58%) patients. Overall, 62 patients (16.5%) returned to the ED after discharge, 41 (18.7%) of laparoscopically operated patients, and 21 (13.4%) of those undergoing open surgery (p = 0.162). Forty-six (12.2%) of them required readmission, 31 (14.2%) after laparoscopic, and 15 (9.6%) after open procedures (p = 0.179). At multivariate regression, a low preoperative physical status (OR 2.3, 95% CI 1.2–4.7; p = 0.017), occurrence of pancreatic fistula (OR 6.8, 95% CI 2.9–15.9; p < 0.001), and post-pancreatectomy hemorrhage (OR 3.9, 95% CI 1.2–13.1; p = 0.025) were significantly associated with 90-day readmission, while laparoscopy had no impact. Median time to reach functional recovery was 5 (IQR 4–6) days. At multivariate analysis, laparoscopy reduced time to functional recovery by 13% (95% CI − 19 to − 6%; p < 0.001), time to adequate oral intake by 19% (95% CI − 27 to − 10%; p < 0.001), and time to adequate pain control by 12% (95% CI − 18 to − 5%; p < 0.001). Conclusion Hospital readmissions and ED visits following DP were not influenced by the surgical approach. A low preoperative physical status, occurrence of postoperative pancreatic fistula and hemorrhage were significantly associated with post-discharge readmission within 90 days. Laparoscopy reduced time to functional recovery. © Springer Science+Business Media, LLC, part of Springer Nature 2020 |
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The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy |
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| score |
7.3986187 |