O'Brien David Patrick
Division of Surgery, University of Cincinnati College of Medicine, 2123 Auburn Avenue, Suite 524, Cincinnati, Ohio 45219, USA.
World J Surg. 2007 Nov;31(11):2138-43. doi: 10.1007/s00268-007-9236-7.
Previous studies have failed to identify predictors of early readmission after major intestinal operations. The objectives of this study were to determine readmission rates, outcomes, and predictors of readmission for patients undergoing laparoscopic colon and rectal operations.
Patients readmitted (PR) to the hospital within 30 days of discharge after laparoscopic colon and rectal operations were identified from a prospectively maintained database. The PR group was compared with patients that were not readmitted (NR). Outcomes and variables related to readmission were evaluated.
There were 820 consecutive elective laparoscopic colon and rectal operations performed over a 5-year period, with adequate follow-up data for 787 cases. Seventy-nine (10%) patients were readmitted. There was no difference in the age, sex, surgeon, or type of operation between the PR and NR groups. The most common causes for readmission were bowel obstruction (19%), ileus (18%), intra-abdominal abscess (14%), and anastomotic leak (9%). Overall mean (median) length of stay (LOS) for the index admission was 3.7 +/- 4.3 (3.0) days. Patients in the PR group had a trend toward a longer index admission LOS than the NR group (5.4 +/- 8.8 [3.0] versus 3.5 +/- 3.3 [3.0], p = 0.068). Univariate analysis demonstrated that patients with inflammatory bowel disease, pulmonary comorbidities, and steroid use were more likely to be readmitted. Multivariate analysis confirmed that inflammatory bowel disease and pulmonary comorbidity are independent risk factors for readmission.
Early readmission after laparoscopic colon and rectal operations is not associated with early discharge. Identification of specific patient characteristics indicating risk for early readmission may allow for selective changes in perioperative care or discharge criteria to avoid unexpected readmission.
既往研究未能确定大肠大手术后早期再入院的预测因素。本研究的目的是确定接受腹腔镜结肠和直肠手术患者的再入院率、结局及再入院的预测因素。
从一个前瞻性维护的数据库中识别出在腹腔镜结肠和直肠手术后出院30天内再次入院的患者（PR组）。将PR组与未再次入院的患者（NR组）进行比较。评估与再入院相关的结局和变量。
在5年期间连续进行了820例择期腹腔镜结肠和直肠手术，787例有充分的随访数据。79例（10%）患者再次入院。PR组和NR组在年龄、性别、手术医生或手术类型方面无差异。再入院的最常见原因是肠梗阻（19%）、肠梗阻（18%）、腹腔内脓肿（14%）和吻合口漏（9%）。首次入院的总体平均（中位数）住院时间（LOS）为3.7±4.3（3.0）天。PR组患者首次入院的LOS有比NR组更长的趋势（5.4±8.8 [3.0] 天对3.5±3.3 [3.0] 天，p = 0.068）。单因素分析表明，患有炎症性肠病、肺部合并症和使用类固醇的患者更有可能再次入院。多因素分析证实，炎症性肠病和肺部合并症是再入院的独立危险因素。
腹腔镜结肠和直肠手术后的早期再入院与早期出院无关。识别表明早期再入院风险的特定患者特征可能有助于选择性地改变围手术期护理或出院标准，以避免意外再入院。
