Murphy Barbara M, Elliott Peter C, Le Grande Michael R, Higgins Rosemary O, Ernest Christine S, Goble Alan J, Tatoulis James, Worcester Marian U C
Heart Research Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Eur J Cardiovasc Prev Rehabil. 2008 Apr;15(2):210-5. doi: 10.1097/HJR.0b013e3282f2dc4e.
Earlier studies show that medical factors and disease severity predict early readmission to hospital after coronary artery bypass graft surgery (CABGS). Few studies have investigated psychosocial predictors. This study investigated medical, sociodemographic and psychosocial predictors of 30-day hospital readmission.
A consecutive sample of 181 patients wait-listed for CABGS completed self-report questionnaires before surgery, and at 2 and 6 months after surgery.
Twenty-six (14.4%) patients were readmitted within 30 days of hospital discharge. Readmitted patients were older (t=2.12, df=179, P=0.035), and more likely to be unmarried (chi=5.80, df=1, P=0.016), live alone (chi=8.33, df=1, P=0.004), have a history of hypertension (chi=2.731, df=1, P=0.098) and have higher anxiety before surgery (t=1.67, df=175, P=0.097). When these variables were entered into a backward stepwise logistic regression, the only significant unique predictor of 30-day readmission was living alone (Wald=7.08, odds ratio=3.42, P=0.008). Patients living alone were over three times more likely than those living with others to be readmitted to hospital. Disease severity and other medical factors were not associated with readmission.
Living alone was identified as the single most important risk factor for early readmission after CABGS. Patients who live alone may benefit from additional support during early convalescence. Intervention studies could explore support options for these patients.
早期研究表明,医学因素和疾病严重程度可预测冠状动脉搭桥手术(CABGS)后患者早期再次入院情况。很少有研究调查心理社会预测因素。本研究调查了30天内再次入院的医学、社会人口学和心理社会预测因素。
对181例等待CABGS手术的患者进行连续抽样,在手术前、术后2个月和6个月完成自我报告问卷。
26例(14.4%)患者在出院后30天内再次入院。再次入院的患者年龄较大(t=2.12,自由度=179,P=0.035),更有可能未婚(卡方=5.80,自由度=1,P=0.016)、独居(卡方=8.33,自由度=1,P=0.004)、有高血压病史(卡方=2.731,自由度=1,P=0.098),且术前焦虑程度较高(t=1.67,自由度=175,P=0.097)。将这些变量纳入向后逐步逻辑回归分析时,30天再次入院的唯一显著独立预测因素是独居(Wald=7.08,比值比=3.42,P=0.008)。独居患者再次入院的可能性是与他人同住患者的三倍多。疾病严重程度和其他医学因素与再次入院无关。
独居被确定为CABGS术后早期再次入院的最重要单一危险因素。独居患者在早期康复期间可能受益于额外的支持。干预研究可以探索针对这些患者的支持方案。