Validation of Discharge Criteria and Risk Factors for Readmission After Pancreatoduodenectomy

BACKGROUND: The optimal timing of hospital discharge after pancreatoduodenectomy remains challenging because objective discharge criteria have not been well established. We aimed to evaluate the clinical validity of our institutional discharge criteria and identify risk factors for unplanned readmission. METHODS: This single-center retrospective study included consecutive patients who underwent pancreatoduodenectomy at our institution between 2007 and 2024. Patients with in-hospital mortality were excluded. Institutional recommended discharge criteria consisted of independent activities of daily living, adequate oral intake, and a declining serum C-reactive protein (CRP) level < 5.0 mg/dL. The primary outcome was the 30-day unplanned readmission rate. Multivariable logistic regression analysis identified risk factors for readmission. RESULTS: Among 976 patients, the median postoperative length of stay was 13 days and the 30-day readmission rate was 9.8% (n = 96). Multivariable analysis showed that postoperative intra-abdominal abscess (odds ratio [OR], 2.82) and serum CRP level ≥ 5.0 mg/dL at discharge (OR, 3.34) were associated with higher risk of readmission. Patients who fulfilled the discharge criteria consistently showed lower readmission rates regardless of postoperative length of stay. CONCLUSIONS: Our objective discharge criteria showed clinical validity, ensuring safe discharge after pancreatoduodenectomy. Patients with postoperative intra-abdominal abscesses may require stricter discharge assessment to reduce the risk of readmission.