JAMA Surg. 2014 May;149(5):439-45. doi: 10.1001/jamasurg.2014.4.
Hospital readmissions are believed to be an indicator of suboptimal care and are the focus of efforts by the Centers for Medicare and Medicaid Services to reduce health care cost and improve quality. Strategies to reduce surgical readmissions may be most effective if applied prospectively to patients who are at increased risk for readmission. Hospitals do not currently have the means to identify surgical patients who are at high risk for unplanned rehospitalizations.
To examine whether the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicted risk of major complications can be used to identify surgical patients at risk for rehospitalization.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 142,232 admissions in the ACS NSQIP registry for major noncardiac surgery.
The association between unplanned 30-day readmission and the ACS NSQIP predicted risk of major complications, controlling for severity of disease and surgical complexity.
Of the 143,232 patients undergoing noncardiac surgery, 6.8% had unplanned 30-day readmissions. The rate of unplanned 30-day readmissions was 78.3% for patients with any postdischarge complication, compared with 12.3% for patients with only in-hospital complications and 4.8% for patients without any complications. Patients at very high risk for major complications (predicted risk of ACS NSQIP complication >10%) had 10-fold higher odds of readmission compared with patients at very low risk for complications (adjusted odds ratio = 10.35; 95% CI, 9.16-11.70), whereas patients at high (adjusted odds ratio = 6.57; 95% CI, 5.89-7.34) and moderate (adjusted odds ratio = 3.96; 95% CI, 3.57-4.39) risk of complications had 7- and 4-fold higher odds of readmission, respectively.
Unplanned readmissions in surgical patients are common in patients experiencing postoperative complications and can be predicted using the ACS NSQIP risk of major complications. Prospective identification of high-risk patients, using the NSQIP complication risk index, may allow hospitals to reduce unplanned rehospitalizations.
医院的再入院率被认为是医疗服务质量欠佳的一个指标，也是医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）降低医疗成本和提高质量的重点。如果将策略前瞻性地应用于有再入院风险的患者，可能会最有效地降低手术再入院率。目前，医院没有办法确定有计划外再住院风险的外科患者。
研究美国外科医师学院国家外科质量改进计划（ACS NSQIP）预测的主要并发症风险是否可用于识别有再住院风险的外科患者。
设计、地点和参与者：回顾性队列研究，对 ACS NSQIP 登记处的 142232 例非心脏大手术患者进行分析。
未计划的 30 天再入院与 ACS NSQIP 预测的主要并发症风险之间的关联，同时控制疾病严重程度和手术复杂性。
在接受非心脏手术的 143232 例患者中，有 6.8%发生了未计划的 30 天再入院。有任何出院后并发症的患者未计划 30 天再入院率为 78.3%，而仅有院内并发症的患者为 12.3%，无任何并发症的患者为 4.8%。预测 ACS NSQIP 并发症风险>10%的极高危患者，其再入院的可能性是并发症极低危患者的 10 倍（调整后优势比=10.35；95%CI，9.16-11.70），而高危（调整后优势比=6.57；95%CI，5.89-7.34）和中度（调整后优势比=3.96；95%CI，3.57-4.39）风险的患者，其再入院的可能性分别是高危患者的 7 倍和 4 倍。
外科患者中未计划的再入院在经历术后并发症的患者中很常见，并且可以使用 ACS NSQIP 主要并发症风险进行预测。前瞻性识别高危患者，并使用 NSQIP 并发症风险指数，可能有助于医院减少计划外再入院。
