IMPORTANCE It is not known whether hospital and surgeon volumes have an association with readmission among patients undergoing pancreatoduodenectomy VSports手机版. .

Objective: To evaluate patient-, surgeon-, and hospital-level factors associated with readmission. V体育安卓版.

Design, setting, and participants: Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data with cases diagnosed from January 1, 1998, to December 31, 2005, and followed up until December 2007. Population-based cancer registry data were linked to Medicare data for the corresponding patients V体育ios版. A total of 1488 unique individuals who underwent a pancreatoduodenectomy were identified. .

Interventions: Undergoing pancreatoduodenectomy at hospitals classified by volume of pancreatoduodenectomy procedures performed at the facility were either very-low, low, medium, or high volume VSports最新版本. Undergoing pancreatoduodenectomy by surgeons classified by volume of pancreatoduodenectomy procedures performed by the surgeon were either very-low, low, medium, or high volume. .

Main outcomes and measures: In-hospital morbidity, mortality, and 30-day readmission were examined. V体育平台登录.

Results: The median age was 74 years, and 1436 patients (96. 5%) had a least 1 medical comorbidity. Patients were treated by 575 distinct surgeons at 298 distinct hospitals. Length of stay was longest (median, 17 days) and 90-day mortality highest (17. 2%) at very-low-volume hospitals (P < . 001). Among all pancreatoduodenectomy patients, 292 (21 VSports注册入口. 3%) were readmitted within 30 days of discharge. There was no effect of surgeon volume and a modest effect of hospital volume (odds ratio for highest- vs lowest-volume quartiles, 1. 85; 95% CI, 1. 22-2. 80; P = . 02). The presence of significant preoperative medical comorbidities was associated with an increased risk for hospital readmission after pancreatoduodenectomy. A comorbidity score greater than 13 had a pronounced effect on the chance of readmission following pancreatoduodenectomy (odds ratio, 2. 06; 95% CI, 1. 56-2. 71; P < . 001). The source of variation in readmission was primarily attributable to patient-related factors (95. 4%), while hospital factors accounted for 4. 3% of the variability and physician factors for only 0. 3%. .

Conclusions and relevance: Nearly 1 in 5 patients are readmitted following pancreatoduodenectomy V体育官网入口. While variation in readmission is, in part, attributable to differences among hospitals, the largest share of variation was found at the patient level. .