Department of Orthopaedics and Sports Medicine, University of Washington, 325 9th Ave. Box 359798, Seattle, WA 98104, USA.
J Bone Joint Surg Am. 2013 Jun 5;95(11):1012-9. doi: 10.2106/JBJS.K.01569.
Reducing hospital readmissions has become a priority in the development of policies aimed at patient safety and cost reduction. Evaluating the incidence of rehospitalization of orthopaedic surgical patients could help to identify targets for more efficient perioperative care. We addressed two questions: What is the incidence of thirty-day readmission for orthopaedic patients at an academic hospital? Can any risk factors for readmission be identified among rehospitalized patients?
This is a retrospective cohort study examining 3264 orthopaedic surgical admissions during two fiscal years from the hospital's quality-improvement database. Cases of patients with unplanned readmission within thirty days were subjected to univariate and multivariate analysis to determine the odds ratio (OR) for readmission. Further descriptive analysis was performed with use of electronic medical record data from the cohort of readmitted patients.
The estimated cumulative incidence of unplanned thirty-day readmissions was 4.2% (i.e., 138 of the 3261 patients who were eligible for the study). Multivariate analysis indicated that marital status of "widowed" significantly increased the risk of readmission (OR, 1.846; 95% confidence interval [CI], 1.070 to 3.184; p = 0.03). Race significantly increased the odds of readmission in patients identified as African-American (OR, 2.178; 95% CI, 1.077 to 4.408; p = 0.03), or American Indian or Alaskan Native race (OR, 3.550; 95% CI, 1.429 to 8.815; p = 0.006). The risk of readmission was significant at p < 0.10 (OR 1.547; 95% CI, 0.941 to 2.545; p = 0.09) for patients with Medicaid insurance. Any intensive care unit stay gave the highest OR of readmission (OR, 2.356; 95% CI, 1.361 to 4.079; p = 0.002) for all demographic groups. Mean length of hospital stay was significantly longer, 5.9 days in the unplanned readmission group compared with 3.6 days for non-readmitted patients (OR, 1.038; 95% CI, 1.014 to 1.062; p = 0.002). Chart review of readmitted patients showed that 102 readmissions (73.9%) were classified as surgical; of these, thirty-five readmission events (34.3%) were for infection at the surgical site.
Longer length of hospital stay or admission to the intensive care unit significantly increased the likelihood of thirty-day readmission, regardless of demographics or discharge disposition. Marital status, Medicaid insurance status, and race may indicate how a patient's social and economic resources can impact his or her risk of being readmitted to the hospital.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
降低医院的再入院率已成为以患者安全和降低成本为目标的政策制定的重点。评估骨科手术患者的再入院发生率有助于确定更有效的围手术期护理目标。我们提出了两个问题：学术医院骨科患者的 30 天再入院率是多少？能否确定再入院患者的再入院风险因素？
这是一项回顾性队列研究，对来自医院质量改进数据库的两个财政年度的 3264 例骨科手术入院病例进行了研究。对 30 天内计划外再入院的病例进行单因素和多因素分析，以确定再入院的比值比（OR）。进一步使用队列中再入院患者的电子病历数据进行描述性分析。
未计划的 30 天再入院的估计累积发生率为 4.2%（即 3261 名符合研究条件的患者中有 138 名）。多因素分析表明，“丧偶”的婚姻状况显著增加了再入院的风险（OR，1.846；95%置信区间[CI]，1.070 至 3.184；p = 0.03）。种族显著增加了被认定为非裔美国人（OR，2.178；95%CI，1.077 至 4.408；p = 0.03）或美国印第安人或阿拉斯加原住民（OR，3.550；95%CI，1.429 至 8.815；p = 0.006）的患者的再入院几率。对于拥有医疗补助保险的患者，再入院的风险在 p < 0.10 时具有统计学意义（OR 1.547；95%CI，0.941 至 2.545；p = 0.09）。任何重症监护病房的住院治疗都会使所有人群的再入院比值比（OR）最高（OR，2.356；95%CI，1.361 至 4.079；p = 0.002）。计划外再入院组的平均住院时间明显长于未再入院组（5.9 天比 3.6 天）（OR，1.038；95%CI，1.014 至 1.062；p = 0.002）。对再入院患者的病历审查显示，102 例再入院（73.9%）被归类为手术；其中，35 例再入院事件（34.3%）为手术部位感染。
无论人口统计学特征或出院情况如何，较长的住院时间或入住重症监护病房都会显著增加 30 天内再入院的可能性。婚姻状况、医疗补助保险状况和种族可能表明患者的社会和经济资源如何影响其再次入院的风险。
预后 II 级。有关证据水平的完整描述，请参见作者说明。
