Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY, 14642, USA,
J Gastrointest Surg. 2014 Jan;18(1):35-43; discussion 43-4. doi: 10.1007/s11605-013-2354-7. Epub 2013 Sep 25.
Preventable readmissions represent a major burden on the health care system and risk stratification of patients can help direct costly resources. This study examines patient characteristics, surgical factors, and postoperative complications associated with 30-day postoperative readmissions in gastrointestinal (GI) resections.
Inpatients undergoing major GI surgery were selected from the 2011 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Resections were classified into foregut, small bowel, colorectal, liver, and pancreatic using Current Procedural Terminology (CPT) codes. Postoperative complications were divided into pre- and post-discharge groups using time to complication and discharge. Univariate analysis compared patient and surgical characteristics and pre-discharge complications with 30-day unplanned readmission rates. Factors with a p value <0.1 were included in multivariate logistic regression. A p value <0.05 was considered statistically significant.
For 42,609 patients undergoing GI resection, the overall 30-day unplanned readmission rate was 12.3 % ranging from 11.8 % for colorectal resections to 16.3 % for pancreatic resections. Major predictors of 30-day readmissions included pre-discharge major complications (odds ratio [OR] = 1.28, 95 % confidence interval [CI] 1.18-1.39, p < 0.0001), chronic steroid use (OR = 1.67, 95 % CI 1.50-1.86, p < 0.0001), operative time ≥4 h (OR = 1.45, 95 % CI 1.35-1.56, p < 0.0001) and discharge to a facility other than home (OR = 1.37, 95 % CI 1.23-1.50, p < 0.0001).
Unplanned 30-day readmissions represent a major clinical and financial concern, but some may be foreseeable and potentially modifiable. This model provides insight into factors that could inform resource utilization and postoperative care to help prevent readmissions in select GI surgical patients.
可预防的再入院对医疗保健系统造成了重大负担，对患者进行风险分层有助于合理分配昂贵的资源。本研究旨在探讨胃肠道（GI）切除术后 30 天内再入院与患者特征、手术因素和术后并发症之间的关系。
从 2011 年美国外科医师学院（ACS）国家外科质量改进计划（NSQIP）数据库中选择接受主要 GI 手术的住院患者。使用手术操作分类（CPT）代码将切除术分为前肠、小肠、结直肠、肝和胰腺切除术。使用并发症发生时间和出院时间将术后并发症分为出院前和出院后两组。单变量分析比较了患者和手术特征以及出院前并发症与 30 天非计划再入院率之间的关系。具有 p 值 <0.1 的因素纳入多变量逻辑回归分析。p 值 <0.05 被认为具有统计学意义。
在 42609 例接受 GI 切除术的患者中，总体 30 天非计划再入院率为 12.3%，范围从结直肠切除术的 11.8%到胰腺切除术的 16.3%。30 天再入院的主要预测因素包括出院前主要并发症（比值比 [OR] = 1.28，95%置信区间 [CI] 1.18-1.39，p <0.0001）、慢性类固醇使用（OR = 1.67，95%CI 1.50-1.86，p <0.0001）、手术时间≥4 小时（OR = 1.45，95%CI 1.35-1.56，p <0.0001）和出院至家庭以外的医疗机构（OR = 1.37，95%CI 1.23-1.50，p <0.0001）。
30 天非计划再入院是一个重大的临床和经济问题，但有些可能是可以预见的，并且可以在一定程度上加以纠正。该模型提供了对可能影响资源利用和术后护理的因素的深入了解，有助于预防特定 GI 手术患者的再入院。
