Lissauer Matthew E, Diaz Jose J, Narayan Mayur, Shah Paulesh K, Hanna Nader N
Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Am Surg. 2013 Jun;79(6):583-8.
Intensive care unit (ICU) readmissions are associated with increased resource use. Defining predictors may improve resource use. Surgical ICU patients requiring readmission will have different characteristics than those who do not. We conducted a retrospective cohort study of a prospectively maintained database. The Acute Physiology and Chronic Health Evaluation (APACHE) IV quality database identified patients admitted January 1 through December 31, 2011. Patients were divided into groups: NREA = patients admitted to the ICU, discharged, and not readmitted versus REA = patients admitted to the ICU, discharged, and readmitted. Comparisons were made at index admission, not readmission. Categorical variables were compared by Fisher's exact testing and continuous variables by t test. Multivariate logistic regression identified independent predictors of readmission. There were 765 admissions. Seventy-seven patients required readmission 94 times (12.8% rate). Sixty-two patients died on initial ICU admission. Admission severity of illness was significantly higher (APACHE III score: 69.54 ± 21.11 vs 54.88 ± 23.48) in the REA group. Discharge acute physiology scores were equal between groups (47.0 ± 39.2 vs 44.2 ± 34.0, P = nonsignificant). In multivariate analysis, REA patients were more likely admitted to emergency surgery (odds ratio, 1.9; 95% confidence interval, 1.01 ± 3.5) more likely to have a history of immunosuppression (2.7, 1.4 ± 5.3) or higher Acute Physiology Score (1.02; 1.0 ± 1.03) than NREA. Patients who require ICU readmission have a different admission profile than those who do not "bounce back." Understanding these differences may allow for quality improvement projects such as instituting different discharge criteria for different patient populations.
重症监护病房（ICU）再入院与资源使用增加相关。确定预测因素可能会改善资源使用情况。需要再入院的外科ICU患者与不需要再入院的患者会有不同的特征。我们对一个前瞻性维护的数据库进行了一项回顾性队列研究。急性生理学与慢性健康状况评估（APACHE）IV质量数据库确定了2011年1月1日至12月31日期间入院的患者。患者被分为两组：NREA = 入住ICU、出院且未再入院的患者，与REA = 入住ICU、出院且再入院的患者。比较是在首次入院时进行，而非再入院时。分类变量通过Fisher精确检验进行比较，连续变量通过t检验进行比较。多变量逻辑回归确定了再入院的独立预测因素。共有765例入院患者。77例患者需要再入院94次（再入院率为12.8%）。62例患者在首次入住ICU时死亡。REA组的入院疾病严重程度显著更高（APACHE III评分：69.54±21.11 vs 54.88±23.48）。两组之间的出院急性生理学评分相等（47.0±39.2 vs 44.2±34.0，P = 无显著差异）。在多变量分析中，与NREA患者相比，REA患者更有可能接受急诊手术（优势比，1.9；95%置信区间，1.01±3.5），更有可能有免疫抑制病史（2.7，1.4±5.3）或更高的急性生理学评分（1.02；1.0±1.03）。需要ICU再入院的患者与那些没有“恢复”的患者有不同的入院特征。了解这些差异可能有助于开展质量改进项目，例如为不同患者群体制定不同的出院标准。
