经皮冠状动脉介入治疗后30天再入院率的相关因素。
Factors associated with 30-day readmission rates after percutaneous coronary intervention.
作者信息
Khawaja Farhan J, Shah Nilay D, Lennon Ryan J, Slusser Joshua P, Alkatib Aziz A, Rihal Charanjit S, Gersh Bernard J, Montori Victor M, Holmes David R, Bell Malcolm R, Curtis Jeptha P, Krumholz Harlan M, Ting Henry H
机构信息
Mayo Clinic, Rochester, MN 55905, USA.
出版信息
Arch Intern Med. 2012 Jan 23;172(2):112-7. doi: 10.1001/archinternmed.2011.569. Epub 2011 Nov 28.
BACKGROUND
Thirty-day readmission rates have become a publicly reported quality performance measure for congestive heart failure, acute myocardial infarction, and percutaneous coronary intervention (PCI). However, little is known regarding the factors associated with 30-day readmission after PCI.
METHODS
To assess the demographic, clinical, and procedural factors associated with 30-day readmission rates after PCI, we identified 15, 498 PCI hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 at Saint Marys Hospital, Rochester, Minnesota. All were included in this analysis. Multivariate logistic regression models were used to estimate the adjusted association between demographic, clinical, and procedural variables and 30-day readmission. The association between 30-day readmission and 1-year mortality was estimated using Cox proportional hazards models with readmission as a time-dependent covariate and by using landmark analysis. The main outcome measures were all-cause 30-day readmission to any hospital following PCI and 1-year mortality.
RESULTS
Overall, 9.4% of PCIs (n = 1459) were readmitted, and 0.68% of PCIs (n = 106) resulted in death within 30 days after discharge. After multivariate analysis, female sex, Medicare insurance, having less than a high school education, unstable angina, cerebrovascular accident or transient ischemic attack, moderate to severe renal disease, chronic obstructive pulmonary disease, peptic ulcer disease, metastatic cancer, and a length of stay of more than 3 days were associated with an increased risk of 30-day readmission after PCI. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality (adjusted hazard ratio, 1.38; 95% CI, 1.08-1.75; P = .009).
CONCLUSIONS
Nearly 1 in 10 patients undergoing PCI were readmitted within 30 days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality.
背景
30天再入院率已成为公开报告的用于评估充血性心力衰竭、急性心肌梗死和经皮冠状动脉介入治疗（PCI）质量的指标。然而，关于PCI术后30天再入院的相关因素知之甚少。
方法
为评估PCI术后30天再入院率的人口统计学、临床和手术相关因素，我们确定了1998年1月至2008年6月在明尼苏达州罗切斯特市圣玛丽医院进行的15498例PCI住院病例（择期或急性冠状动脉综合征）。所有病例均纳入本分析。采用多因素逻辑回归模型估计人口统计学因素、临床因素和手术变量与30天再入院之间的校正关联。采用Cox比例风险模型，将再入院作为时间依赖性协变量，并通过地标分析来估计30天再入院与1年死亡率之间的关联。主要结局指标为PCI术后30天内因任何原因再次入住任何医院以及1年死亡率。
结果
总体而言，9.4%（n = 1459）的PCI患者在30天内再次入院，0.68%（n = 106）的PCI患者在出院后30天内死亡。多因素分析后，女性、医疗保险、高中以下学历、不稳定型心绞痛、脑血管意外或短暂性脑缺血发作、中重度肾病、慢性阻塞性肺疾病、消化性溃疡疾病、转移性癌症以及住院时间超过3天与PCI术后30天再入院风险增加相关。PCI术后30天再入院与1年死亡率较高相关（校正风险比为1.38；95%可信区间为1.08 - 1.75；P = 0.009）。
结论
近十分之一接受PCI的患者在30天内再次入院。PCI术后30天再入院与1年死亡率较高相关。
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