Kim Bobby D, Ver Halen Jon P, Lim Seokchun, Kim John Y S
Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL.
Microsurgery. 2015 Jan;35(1):13-20. doi: 10.1002/micr.22230. Epub 2014 Jan 28.
Unplanned readmissions serve as a marker for health care quality. Risk factors associated with unplanned readmission after microvascular free tissue transfer have never been examined. In this study, we sought to identify perioperative predictors of 30-day unplanned readmission in free flap patients.
The National Surgical Quality Improvement Program (NSQIP) database was retrospectively reviewed to identify all patients who underwent microvascular free tissue transfer in 2011. Multivariate logistic regression models were used to estimate independent predictors of unplanned readmission.
Among free flap patients, unplanned readmission rate was 7.9%. In multivariate analysis, the only factor that significantly predicted unplanned readmission (P < 0.05) was open wound/wound infection (odds ratio [OR] 2.71). Postoperative variables significantly associated with unplanned readmission included surgical complications (OR 5.43), medical complications (OR 5.62), and unplanned reoperation (OR 3.94). Flap failure was not associated with unplanned readmission.
In our study, the presence of either open wound/wound infection, development of surgical complications, medical complications, and unplanned reoperations were associated with unplanned readmissions. Further research in predictive factors is suggested to avoid costly, unnecessary, and preventable readmissions.
非计划再入院是医疗质量的一个指标。微血管游离组织移植术后非计划再入院的相关危险因素从未被研究过。在本研究中，我们试图确定游离皮瓣患者30天非计划再入院的围手术期预测因素。
回顾性分析国家外科质量改进计划（NSQIP）数据库，以确定2011年所有接受微血管游离组织移植的患者。采用多因素逻辑回归模型来估计非计划再入院的独立预测因素。
在游离皮瓣患者中，非计划再入院率为7.9%。在多因素分析中，唯一显著预测非计划再入院的因素（P < 0.05）是开放性伤口/伤口感染（比值比[OR] 2.71）。与非计划再入院显著相关的术后变量包括手术并发症（OR 5.43）、医疗并发症（OR 5.62）和非计划再次手术（OR 3.94）。皮瓣失败与非计划再入院无关。
在我们的研究中，开放性伤口/伤口感染、手术并发症、医疗并发症的发生以及非计划再次手术与非计划再入院有关。建议对预测因素进行进一步研究，以避免代价高昂、不必要且可预防的再入院。
