Specific Medicare Severity-Diagnosis Related Group Codes Increase the Predictability of 30-Day Unplanned Hospital Readmission After Pancreaticoduodenectomy.
Background: The Medicare Severity-Diagnosis Related Group coding system (MS-DRG) is routinely used by hospitals for reimbursement purposes following pancreatic surgery. We aimed to determine whether specific pancreatectomy MS-DRG codes, when combined with distinct clinicopathologic and perioperative...
| Publicado en: | Journal of Gastrointestinal Surgery Vol. 22; no. 11; pp. 1920 - 1928 |
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| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Elsevier B.V.
Nov2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132880584&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 132880584 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1091255X KIT jtl: Journal of Gastrointestinal Surgery issn: 1091255X maglogo: N pubinfo: dt: Nov2018 vid: 22 iid: 11 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 132880584 132880584 NLM30039447 10.1007/s11605-018-3879-6 NLM30039447 132880584 ppf: 1920 ppct: 8 formats: tig: atl: Specific Medicare Severity-Diagnosis Related Group Codes Increase the Predictability of 30-Day Unplanned Hospital Readmission After Pancreaticoduodenectomy. aug: au: Xourafas, Dimitrios Merath, Katiuscha Spolverato, Gaya Ashley, Stanley W. Cloyd, Jordan M. Pawlik, Timothy M. affil: Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA sug: subj: Pancreaticoduodenectomy Statistics and Numerical Data Pancreatic Neoplasms Pathology Pancreatic Neoplasms Surgery Diagnosis-Related Groups Readmission Statistics and Numerical Data Male Neoplasm Staging Neoplasm Metastasis Middle Age Aged, 80 and Over Pancreaticoduodenectomy Adverse Effects Comorbidity Adult Pancreatectomy Young Adult Surgery, Cardiovascular United States Cholestasis Complications Risk Factors Medicare Aged Postoperative Complications Etiology Female Scales Middle Aged: 45-64 years Aged, 80 & over Adult: 19-44 years Aged: 65+ years Male Female ab: Background: The Medicare Severity-Diagnosis Related Group coding system (MS-DRG) is routinely used by hospitals for reimbursement purposes following pancreatic surgery. We aimed to determine whether specific pancreatectomy MS-DRG codes, when combined with distinct clinicopathologic and perioperative characteristics, increased the accuracy of predicting 30-day readmission after pancreaticoduodenectomy (PD).Methods: Demographic, clinicopathologic, and perioperative factors were compared between readmitted and non-readmitted patients at Brigham and Women's Hospital following PD. Different pancreatectomy DRG codes, currently used for reimbursement purposes [407: without complication/co-morbidity (CC), 406: with CC, and 405: with major CC] were combined with clinical factors to assess their predictability of readmission. Univariate and multivariable analyses were performed to evaluate outcomes.Results: Among 354 patients who underwent PD between 2010 and 2017, 69 (19%) were readmitted. The incidence of readmission was 13, 32, and 55% for patients with assigned DRG codes 407, 406, and 405, respectively (P = 0.0395). Readmitted patients were more likely to have had T4 disease (P = 0.0007), a vascular resection (P = 0.0078), and longer operative times (P = 0.012). On multivariable analysis, combining DRG 407 with relevant clinicopathologic factors was unable to predict readmission. In contrast, DRG 406 code among patients with N positive disease (P = 0.0263) and LOS > 10 days (P = 0.0505) was associated with readmission. DRG 405, preoperative obstructive jaundice (OR: 7.5, CI: 1.5-36, P = 0.0130), vascular resection (OR: 7.7, CI: 1.1-51, P = 0.0336), N positive stage of disease (OR: 0.2, CI: 0-0.9, P = 0.0447), and operative time > 410 min (OR: 5.9, CI: 1-32, P = 0.0399) were each strongly associated with 30-day readmission after PD [likelihood ratio (LR) < 0.0001].Conclusions: Distinct pancreatectomy MS-DRG classification codes (405), combined with relevant clinicopathologic and perioperative characteristics, strongly predicted 30-day readmission after PD. DRG classification algorithms can be implemented to more accurately identify patients at a higher risk of readmission. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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