结直肠切除术后的早期出院和再入院。

Early discharge and readmission after colorectal resection.

机构信息

Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

J Surg Res. 2014 Aug;190(2):579-86. doi: 10.1016/j.jss.2014.02.006. Epub 2014 Feb 15.

DOI:10.1016/j.jss.2014.02.006

PMID:24661387

Abstract

BACKGROUND

Emphasis on the provision of high quality, cost-effective healthcare has meant increasing efforts at reducing postoperative length of stay while reducing 30-d readmission rates. The aim of this study was to identify factors associated with early discharge (ED) and to evaluate the effectof ED on readmission after colorectal resection.

MATERIALS AND METHODS

We identified all inpatients aged ≥18 y who underwent a colorectal resection in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, 2011. ED was defined as a length of stay ≤25th percentile by procedure (rectal resection, open colectomy, and laparoscopic colectomy). Multivariate logistic regression was used to identify factors significantly associated with ED and readmission. A subset analysis was performed by procedure type.

RESULTS

Of 28,532 patients, 2171 (7%) underwent rectal resection, 14,976 (52%) underwent open colectomy, and 11,385 (40%) underwent laparoscopic colectomy with an ED on or before postoperative days 5, 5, and 3, respectively. The overall cohort included patients with a mean age of 61 y. A total of 52% were women and 37% were colorectal cancer patients. Age >65 y, recent steroid use, simultaneous ostomy creation, nonelective surgery, need for reoperation, and a postoperative occurrence before discharge were significantly associated with a reduced likelihood of ED. The overall rate of readmission was 12%. Patients who were discharged early were significantly less likely to be readmitted (odds ratio, 0.77; 95% confidence interval, 0.70-0.84).

CONCLUSIONS

In the appropriate patient population, ED after colorectal surgery may be implemented without any adverse effect on readmission rates.

摘要

背景

强调提供高质量、高性价比的医疗保健意味着要加大努力，在降低术后住院时间的同时降低 30 天再入院率。本研究的目的是确定与早期出院（ED）相关的因素，并评估结直肠切除术后 ED 对再入院的影响。

材料和方法

我们在美国外科医师学院国家手术质量改进计划参与者使用文件中确定了所有年龄≥18 岁的接受结直肠切除术的住院患者，2011 年。ED 定义为通过手术（直肠切除术、开腹结肠切除术和腹腔镜结肠切除术）的住院时间≤第 25 个百分位数。多变量逻辑回归用于确定与 ED 和再入院显著相关的因素。按手术类型进行亚组分析。

结果

在 28532 名患者中，2171 名（7%）接受直肠切除术，14976 名（52%）接受开腹结肠切除术，11385 名（40%）接受腹腔镜结肠切除术，术后第 5、5 和 3 天分别进行 ED。整个队列包括平均年龄为 61 岁的患者。女性占 52%，结直肠癌患者占 37%。年龄>65 岁、近期使用类固醇、同时进行造口术、非择期手术、需要再次手术以及出院前出现术后并发症与 ED 的可能性降低显著相关。总的再入院率为 12%。早期出院的患者再入院的可能性显著降低（比值比，0.77；95%置信区间，0.70-0.84）。