Spolverato Gaya, Ejaz Aslam, Kim Yuhree, Weiss Mattew, Wolfgang Christopher L, Hirose Kenzo, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
HPB (Oxford). 2014 Nov;16(11):972-8. doi: 10.1111/hpb.12262. Epub 2014 Apr 9.
Reducing readmission is a key quality improvement target for policymakers. The purpose of the present study was to define incidence and identify factors associated with readmission after a hepatic resection.
Thirty-day readmission after discharge and factors associated with a higher risk of readmission were examined among patients undergoing a hepatic resection at Johns Hopkins Hospital between 2008 and 2012.
Among the 338 patients, the median age was 57.9 years and 173 (51.2%) were men. Indications for surgery included colorectal cancer liver metastasis (38.2%), primary hepatic tumours (25.7%) and benign disease (3.3%). Surgical resection consisted of less than a hemi-hepatectomy in the majority of patients (n = 224, 66.3%). The median index hospitalization length-of-stay (LOS) was 5 days; 68.7% patients experienced at least one inpatient complication. Overall 30-day readmission was 14.2% (n = 48). The majority of readmitted patients (n = 46, 95.8%) had a complication prior to readmission. The median LOS for readmission was 4 [interquartile range (IQR) 2-6] days. On multivariable analysis, the strongest independent predictor of readmission was the presence of a major complication [odds ratio (OR) 5.30, 95% confidence interval (CI) 2.38-11.78, P < 0.001].
Readmission after a hepatic resection occurs in approximately one out of every seven patients. Patients who experience a post-operative complication are greater than five times more likely to be readmitted. Prospective studies are needed to evaluate methods to reduce unplanned readmissions.
降低再入院率是政策制定者提高医疗质量的关键目标。本研究的目的是确定肝切除术后再入院的发生率，并识别与之相关的因素。
对2008年至2012年间在约翰霍普金斯医院接受肝切除手术的患者进行了出院后30天再入院情况及与再入院高风险相关因素的调查。
338例患者中，年龄中位数为57.9岁，男性173例（51.2%）。手术指征包括结直肠癌肝转移（38.2%）、原发性肝肿瘤（25.7%）和良性疾病（3.3%）。大多数患者（n = 224，66.3%）的手术切除范围小于半肝切除。首次住院的中位住院时长（LOS）为5天；68.7%的患者至少发生过一次住院并发症。总体30天再入院率为14.2%（n = 48）。大多数再入院患者（n = 46，95.8%）在再入院前出现过并发症。再入院的中位LOS为4[四分位间距（IQR）2 - 6]天。多变量分析显示，再入院最强的独立预测因素是存在严重并发症[比值比（OR）5.30，95%置信区间（CI）2.38 - 11.78，P < 0.001]。
肝切除术后约七分之一的患者会再次入院。术后出现并发症的患者再次入院的可能性高出五倍多。需要进行前瞻性研究以评估降低非计划再入院率方法。
