Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Geriatr Soc. 2013 Jul;61(7):1175-81. doi: 10.1111/jgs.12307. Epub 2013 Jun 3.
A systematic review and meta-analysis of the current literature was conducted to compare the overall and cause-specific readmission rates after colorectal surgery of older adults with those of younger individuals. Potential predictors of unplanned readmission were also identified. Estimated pooled readmission rates were calculated and reported as pooled proportions with associated 95% confidence intervals (CI) in 60,131 total readmissions; 11.0% (95% CI = 10.0-12.0) of all admissions after colorectal surgery resulted in unplanned readmission at 30 days. Older adults had a lower rate of readmission than younger individuals. Bowel obstruction was the most common cause of unplanned readmission, accounting for 33.4% of all unplanned readmissions, followed by surgical site infection (15.7%) and intraabdominal abscess (12.6%). Several age-related predictors of unplanned readmission were identified, such as poor functional capacity, multiple comorbidities, chronic obstructive pulmonary disease, and discharge to a nonhome destination. The findings of this review will help guide the development of future interventions to reduce preventable readmissions after colorectal surgery in older adults.
本研究对现有文献进行了系统回顾和荟萃分析，旨在比较老年患者与年轻患者结直肠手术后总体和特定病因的再入院率，并确定非计划性再入院的潜在预测因素。估计汇总的再入院率，并以汇总比例及其相关 95%置信区间（CI）报告，总计 60131 例再入院中，11.0%（95%CI=10.0-12.0）的结直肠手术后入院患者在 30 天内发生非计划性再入院。与年轻患者相比，老年患者的再入院率较低。肠梗阻是导致非计划性再入院的最常见原因，占所有非计划性再入院的 33.4%，其次是手术部位感染（15.7%）和腹腔脓肿（12.6%）。本研究还确定了一些与年龄相关的非计划性再入院预测因素，例如功能状态差、多种合并症、慢性阻塞性肺疾病以及出院至非家庭目的地等。本研究结果将有助于指导未来干预措施的制定，以减少老年结直肠手术后可预防的再入院。
