种族会影响危重症疾病后的再入院情况吗？

Epstein Carol Diane, Tsaras Geoffrey, Amoateng-Adjepong Yaw, Greiner Philip A, Manthous Constantine

Lienhard School of Nursing, Pace University, Pleasantville, New York 10570, USA.

Heart Lung. 2009 Jan-Feb;38(1):66-76. doi: 10.1016/j.hrtlng.2008.01.001. Epub 2008 Sep 30.

OBJECTIVE

To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients.

METHODS

Racial status is a risk factor for early (within 7 days) hospital readmission after initial recovery from critical illness and respiratory failure. This was a retrospective cohort study that took place in a 350-bed community hospital. Adult patients who received mechanical ventilation during their intensive care unit stay were included. Study subjects were categorized as white, black (non-Hispanic), Hispanic, and Asian/other. The main outcome measure was readmission to the hospital within 7 days of discharge. Secondary outcomes were hospital mortality and durations of hospital and intensive care unit stay. Comparisons were made across racial groups.

RESULTS

Of 772 patients, 172 (22.3%) died, and 96 of the 591 discharged patients (16.2%) were readmitted within 7 days. Race was not a determinant of rapid readmission: 11.6% of blacks (P = .2), 20.6% of Hispanics (P = .3) and 16.5% of whites were readmitted within 7 days. Readmitted patients were more likely to have been discharged to a rehabilitation or extended care facility rather than to home (22.1% vs 2.2%, P < .0001). Readmitted patients tended to have had prolonged duration of mechanical ventilation > or = 30 days (41% vs 15.1%, P = .004), to be aged > or = 80 years (24.4% vs 13.9%, P = .005), and to be female (19.5% vs 13.7%, P = .04). Multivariate logistic regression analyses demonstrated that discharge to a place other than home (odds ratio 10.1, 95% confidence interval 3.6-28.3) and prolonged duration of mechanical ventilation (odds ratio 2.8, 95% confidence interval 1.1-6.9) were independently associated with readmission. Race did not significantly influence in-hospital mortality. Overall, the deceased were older and more likely to be female, and had longer durations of mechanical ventilation and medical and surgical intensive care unit stays.

CONCLUSION

Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.

目的

探讨种族对危重症患者出院后7天内再入院率的影响。

方法

种族状况是危重症和呼吸衰竭初步康复后早期（7天内）再入院的一个危险因素。这是一项在一家拥有350张床位的社区医院进行的回顾性队列研究。纳入在重症监护病房住院期间接受机械通气的成年患者。研究对象分为白人、黑人（非西班牙裔）、西班牙裔和亚洲人/其他种族。主要结局指标是出院后7天内再次入院。次要结局指标是医院死亡率以及住院和重症监护病房住院时间。对不同种族群体进行了比较。

结果

772例患者中，172例（22.3%）死亡，591例出院患者中有96例（16.2%）在7天内再次入院。种族不是快速再入院的决定因素：7天内再次入院的患者中，黑人占11.6%（P = 0.2），西班牙裔占20.6%（P = 0.3），白人占16.5%。再次入院的患者更有可能被转至康复机构或长期护理机构而非回家（22.1%对2.2%，P < 0.0001）。再次入院的患者往往机械通气时间延长≥30天（41%对15.1%，P = 0.004），年龄≥80岁（24.4%对13.9%，P = 0.005），且为女性（19.5%对13.7%，P = 0.04）。多因素逻辑回归分析表明，出院后转至非家庭场所（比值比10.1，95%置信区间3.6 - 28.3）和机械通气时间延长（比值比2.8，95%置信区间1.1 - 6.9）与再入院独立相关。种族对院内死亡率无显著影响。总体而言，死亡患者年龄更大，更可能为女性，机械通气时间更长，在内科和外科重症监护病房住院时间也更长。