Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA.
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Am J Surg. 2014 Mar;207(3):346-51; discussion 350-1. doi: 10.1016/j.amjsurg.2013.09.008. Epub 2013 Dec 11.
To evaluate readmissions to determine predictors and patterns of readmission.
Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined.
A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older (P = .003), had more comorbidities (P < .0001), longer operative times (P < .0001), length of stay (P < .0001), and higher costs (P = .002). At the time of discharge, more readmitted patients required temporary nursing (P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time (P = .05) and LOS were longer (P = .028), and more patients required temporary nursing care at the time of discharge (P = .046). Readmissions caused an additional mean hospital cost of $12,670.89.
Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.
评估再入院以确定再入院的预测因素和模式。
前瞻性数据库回顾确定了结直肠手术后再入院和非再入院的患者。检查了索引和再入院事件的变量。
共分析了 212 例再入院和 3292 例非再入院。大多数是择期手术。再入院患者年龄较大（P =.003），合并症较多（P <.0001），手术时间较长（P <.0001），住院时间较长（P <.0001），费用较高（P =.002）。出院时，更多的再入院患者需要临时护理（P <.0001）。独立的再入院预测因素是美国麻醉医师协会评分较高、既往腹部手术、重症监护病房住院和动力/便秘手术。再入院时，29.2%需要再次手术。最初超过一半的患者采用了开放手术（55.2%）。初次开放手术后，再次手术时间（P =.05）和 LOS 更长（P =.028），且更多患者在出院时需要临时护理（P =.046）。再入院导致医院平均额外费用为 12670.89 美元。
再入院患者具有明显的人口统计学和结局变量。由于大多数是择期病例，因此术前对患者进行分层可能会使这个高风险群体的围手术期计划受益。
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