Association of discharge home with home health care and 30-day readmission after pancreatectomy

Abstract

Background: We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission after pancreatectomy.

Study design: We examined 30-day readmissions in patients undergoing pancreatectomy using the Healthcare Cost and Utilization Project State Inpatient Database for California from 2009 to 2011. Readmissions were categorized as severe or nonsevere using the Modified Accordion Severity Grading System. Multivariable logistic regression models were used to examine the association of discharge home with HHC and 30-day readmission using discharge home without HHC as the reference group. Propensity score matching was used as an additional analysis to compare the rate of 30-day readmission between patients discharged home with HHC with patients discharged home without HHC.

Results: Of 3,573 patients who underwent pancreatectomy, 752 (21.0%) were readmitted within 30 days of discharge. In a multivariable logistic regression model, discharge home with HHC was an independent predictor of increased 30-day readmission (odds ratio = 1.37; 95% CI, 1.11-1.69; p = 0.004). Using propensity score matching, patients who received HHC had a significantly increased rate of 30-day readmission compared with patients discharged home without HHC (24.3% vs 19.8%; p < 0.001). Patients discharged home with HHC had a significantly increased rate of nonsevere readmission compared with those discharged home without HHC, by univariate comparison (19.2% vs 13.9%; p < 0.001), but not severe readmission (6.4% vs 4.7%; p = 0.08). In multivariable logistic regression models, excluding patients discharged to facilities, discharge home with HHC was an independent predictor of increased nonsevere readmissions (odds ratio = 1.41; 95% CI, 1.11-1.79; p = 0.005), but not severe readmissions (odds ratio = 1.31; 95% CI, 0.88-1.93; p = 0.18).

Conclusions: Discharge home with HHC after pancreatectomy is an independent predictor of increased 30-day readmission; specifically, these services are associated with increased nonsevere readmissions, but not severe readmissions.

Figure 1

Most frequent primary diagnosis categories for readmission as percentages of total readmissions (n = 752). Surgical Comp, surgery-specific complications; FTT/Nature, failure to thrive/nature of illness; Healthcare Infections, UTI, C. difficile colitis, and central venous catheter infections; Pulmonary Comp, respiratory failure/insufficiency, including pneumonia.

Figure 2

(A) Comparison of readmission rates for non-severe (n = 466) and severe (n = 158) readmissions between patients discharged home without (n=2317) and with (n=754) home health care. (B) Comparison of the top three primary readmission diagnosis categories for non-severe readmissions (n = 466) between patients discharged home without (n=321) and with (n=145) home health care. Surgical Comp, surgery-specific complications; FTT/Nature, failure to thrive/nature of illness. p Values are by Chi-square test.