Department of Cardiology, Geisinger Medical Center, Danville, PA 17822, USA.
JACC Cardiovasc Interv. 2013 Mar;6(3):237-44. doi: 10.1016/j.jcin.2012.10.015.
This study sought to identify the frequency and etiology of readmission within 30 days of percutaneous coronary intervention (PCI) in a large integrated healthcare system.
One-fifth of Medicare patients are readmitted within 30 days of hospitalization. Identifying the causes of readmission may help identify strategies to prevent readmission.
All patients undergoing PCI (elective, urgent, and emergent) at our center between January 1, 2007, and April 12, 2010, were prospectively entered into the American College of Cardiology National Cardiovascular Data Registry. Patients readmitted to any hospital within 30 days of the index procedure were identified using an administrative database and telephone follow-up. Individual charts were reviewed independently by 2 investigators; disagreements regarding the cause for readmission were resolved by a third investigator.
During the study period, 3,255 PCI were performed, and 262 patients (8.0%) were readmitted within 30 days. Of these, 261 (99.6%) had medical records available for review. Reasons for readmission included: complications related to the PCI (n = 31, 11.9%); non-PCI cardiac causes related to index admission (n = 93, 35.6%); noncardiac causes related to index admission (n = 34, 13%); causes unrelated to the index admission (n = 103, 39.5%). Multivariable logistic regression modeling revealed that female sex, advanced age, peripheral arterial disease, prior valvular surgery, and PCI complications during the index procedure were associated with 30-day readmission.
Readmissions within 30 days due to complications related to PCI performed on index admission are rare (0.9% of all PCI) and are an infrequent cause of readmission (<12% of readmissions). Thirty-day readmission after PCI should not be used as a quality metric of PCI performance.
本研究旨在确定在大型综合医疗保健系统中，经皮冠状动脉介入治疗（PCI）后 30 天内再入院的频率和病因。
五分之一的 Medicare 患者在住院后 30 天内再次入院。确定再入院的原因可能有助于确定预防再入院的策略。
2007 年 1 月 1 日至 2010 年 4 月 12 日期间，在我们中心接受 PCI（择期、紧急和紧急）的所有患者均前瞻性地纳入美国心脏病学会国家心血管数据注册中心。使用行政数据库和电话随访确定索引手术后 30 天内入住任何医院的患者。两名研究人员分别独立审查病历；对再入院原因的分歧由第三名研究人员解决。
在研究期间，进行了 3255 次 PCI，262 例（8.0%）患者在 30 天内再入院。其中，261 例（99.6%）有病历可供审查。再入院的原因包括：与 PCI 相关的并发症（n=31，11.9%）；与索引入院相关的非 PCI 心脏原因（n=93，35.6%）；与索引入院相关的非心脏原因（n=34，13%）；与索引入院无关的原因（n=103，39.5%）。多变量逻辑回归模型显示，女性、高龄、外周动脉疾病、既往瓣膜手术以及索引手术期间的 PCI 并发症与 30 天再入院相关。
索引入院期间因 PCI 相关并发症导致的 30 天内再入院罕见（所有 PCI 的 0.9%），且是再入院的一个不常见原因（<12%的再入院）。PCI 后 30 天再入院不应作为 PCI 效果的质量指标。
