The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery a
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and Other Interventional Techniques
2020 SAGES ORAL
The impact of minimally invasive surgery on hospital readmissions, emergency department visits and functional recovery after distal pancreatectomy Nicolò Pecorelli1 · Giovanni Guarneri1 · Kemal Alagol2 · Michele Mazza2 · Roberto Quattromani2 · Stefano Partelli1,2 · Stefano Crippa1,2 · Renato Castoldi1 · Gianpaolo Balzano1 · Massimo Falconi1,2 Received: 4 April 2020 / Accepted: 26 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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
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