Thirty-Day Readmission After Radical Gastrectomy for Gastric Cancer: A Meta-analysis

Abstract

Background: Readmission is a commonly accepted parameter to evaluate surgical quality, but previous studies reported inconsistent results in radical gastrectomy. The purpose of our study is to clarify the prevalence, potential causes, and risk factors of 30-d readmission after radical gastrectomy for gastric cancer.

Methods: PubMed and Embase were systematically searched from inception to September 2018 for any possible inclusion. Prevalence, potential causes, and risk factors of 30-d readmission in included studies were extracted using a standardized EXCEL table. The overall 30-d readmission rate was pooled using a random-effects model. Odds ratios with 95% confidence intervals were used to estimate potential risk factors for 30-d readmission. Publication bias was assessed using a funnel plot and statistical tests.

Results: A total of nine studies with 16,581 patients were included in the current meta-analysis. The pooled 30-d readmission rate after radical gastrectomy was 8% (95% confidence interval, 0.04-0.12). Nutritional difficulty and surgical site infections were the main causes for 30-d readmission. Cardiovascular comorbidity, total gastrectomy, nutritional risk screening 2002 score ≥3, any complications, laparoscopic gastrectomy, and C-reactive protein on postoperative day 3 ≥12 were strong predictors for 30-d readmission, whereas combined multiorgan resection was a weaker predictor. No significant publication bias was identified through the funnel plot and statistical tests.

Conclusions: The 30-d readmission rate after radical gastrectomy ranges from 4% to 12% and can mainly result from nutritional difficulty and surgical site infections. Nutritional risk screening 2002 score ≥3, cardiovascular comorbidity, total gastrectomy, any complications, and laparoscopic gastrectomy were potential risk factors for 30-d readmission.

Keywords: Gastrectomy; Gastric cancer; Meta-analysis; Readmission.