Saharan Sunil, Legg Arthur T, Armsby Laurie B, Zubair M Mujeeb, Reed Richard D, Langley Stephen M
Division of Pediatric Cardiology, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
Division of Pediatric Cardiology, Department of Pediatrics and Surgery, Doernbecher Children's Hospital, Portland, Oregon.
Ann Thorac Surg. 2014 Nov;98(5):1667-73. doi: 10.1016/j.athoracsur.2014.05.043. Epub 2014 Aug 15.
Readmission after operations for congenital heart conditions has significant implications for patient care. Readmission rates vary between 8.7% and 15%. The aim of this study was to determine the incidence, causes, and risk factors associated with readmission.
811 consecutive patients undergoing operations for congenital heart conditions were analyzed. Readmission was defined as admission to any hospital within 30 days of discharge for any cause. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate comparisons were made between the nonreadmission and readmission groups, and multivariate logistic regression analysis was made to determine independent risk factors for readmission.
There were a total of 92 readmissions in 79 patients (9.7%). The reasons included cardiac (36, 39%), pulmonary (20, 22%), gastrointestinal (13, 14%), infectious (20, 22%), and other adverse events (2, 2%). Patients with either single-ventricle palliation or nasogastric feeding accounted for 40 (50%) readmissions. On univariate analysis, there were significant differences between readmitted and nonreadmitted patients in relation to patient age, chromosomal abnormality, mortality risk score, duration of mechanical ventilation, postoperative length of stay, single-ventricle physiology, and nasogastric feeding at discharge (p < 0.05). On multivariate analysis, significant risk factors for readmission were single-ventricle physiology (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.28 to 4.47; p=0.005), preoperative arrhythmia (OR 2.59; 95% CI 1.02 to 6.59; p=0.04), longer postoperative length of stay (OR 2.2; 95% CI 1.22 to 3.99; p=0.008), and nasogastric tube feeding at discharge (OR 2.2; 95% CI 1.15 to 4.19; p=0.01).
The incidence of readmission after operations for congenital cardiac conditions remains high. Efforts focusing on patients with single-ventricle palliation and those with preoperative arrhythmia, prolonged postoperative length of stay and nasogastric tube feeding at discharge may be particularly beneficial.
先天性心脏病手术后的再入院对患者护理具有重大影响。再入院率在8.7%至15%之间。本研究的目的是确定再入院的发生率、原因及相关危险因素。
对811例连续接受先天性心脏病手术的患者进行分析。再入院定义为出院后30天内因任何原因入住任何医院。对人口统计学、术前、手术及术后变量进行评估。对未再入院组和再入院组进行单因素比较，并进行多因素逻辑回归分析以确定再入院的独立危险因素。
79例患者中共发生92次再入院（9.7%）。原因包括心脏问题（36例，39%）、肺部问题（20例，22%）、胃肠道问题（13例，14%）、感染（20例，22%）及其他不良事件（2例，2%）。单心室姑息治疗或鼻饲喂养的患者占再入院患者的40例（50%）。单因素分析显示，再入院患者与未再入院患者在年龄、染色体异常、死亡风险评分、机械通气时间、术后住院时间、单心室生理状态及出院时鼻饲喂养方面存在显著差异（p<0.05）。多因素分析显示，再入院的显著危险因素为单心室生理状态（比值比[OR]2.39；95%置信区间[CI]1.28至4.47；p = 0.005）、术前心律失常（OR 2.59；95%CI 1.02至6.59；p = 0.04）、术后住院时间延长（OR 2.2；95%CI 1.22至3.99；p = 0.008）及出院时鼻饲管喂养（OR 2.2；95%CI 1.15至4.19；p = 0.01）。
先天性心脏病手术后再入院的发生率仍然很高。关注单心室姑息治疗患者、术前心律失常患者、术后住院时间延长患者及出院时鼻饲管喂养患者可能特别有益。
