Sanford Dominic E, Olsen Margaret A, Bommarito Kerry M, Shah Manish, Fields Ryan C, Hawkins William G, Jaques David P, Linehan David C
Department of Surgery, Barnes-Jewish Hospital, St Louis, MO; Department of Surgery, Washington University School of Medicine, St Louis, MO.
Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO.
J Am Coll Surg. 2014 Nov;219(5):875-86.e1. doi: 10.1016/j.jamcollsurg.2014.07.008. Epub 2014 Jul 18.
BACKGROUND: We sought to determine if discharge home with home health care (HHC) is an independent predictor of increased readmission after pancreatectomy. STUDY DESIGN: We examined 30-day readmissions in patients undergoing pancreatectomy using the Healthcare Cost and Utilization Project State Inpatient Database for California from 2009 to 2011. Readmissions were categorized as severe or nonsevere using the Modified Accordion Severity Grading System. Multivariable logistic regression models were used to examine the association of discharge home with HHC and 30-day readmission using discharge home without HHC as the reference group. Propensity score matching was used as an additional analysis to compare the rate of 30-day readmission between patients discharged home with HHC with patients discharged home without HHC. RESULTS: Of 3,573 patients who underwent pancreatectomy, 752 (21.0%) were readmitted within 30 days of discharge. In a multivariable logistic regression model, discharge home with HHC was an independent predictor of increased 30-day readmission (odds ratio = 1.37; 95% CI, 1.11-1.69; p = 0.004). Using propensity score matching, patients who received HHC had a significantly increased rate of 30-day readmission compared with patients discharged home without HHC (24.3% vs 19.8%; p < 0.001). Patients discharged home with HHC had a significantly increased rate of nonsevere readmission compared with those discharged home without HHC, by univariate comparison (19.2% vs 13.9%; p < 0.001), but not severe readmission (6.4% vs 4.7%; p = 0.08). In multivariable logistic regression models, excluding patients discharged to facilities, discharge home with HHC was an independent predictor of increased nonsevere readmissions (odds ratio = 1.41; 95% CI, 1.11-1.79; p = 0.005), but not severe readmissions (odds ratio = 1.31; 95% CI, 0.88-1.93; p = 0.18). CONCLUSIONS: Discharge home with HHC after pancreatectomy is an independent predictor of increased 30-day readmission; specifically, these services are associated with increased nonsevere readmissions, but not severe readmissions.
背景：我们试图确定出院后接受家庭医疗保健（HHC）是否是胰腺切除术后再入院率增加的独立预测因素。 研究设计：我们使用2009年至2011年加利福尼亚州医疗保健成本与利用项目州住院数据库，对接受胰腺切除术的患者的30天再入院情况进行了研究。使用改良的手风琴严重程度分级系统将再入院分为严重或非严重。多变量逻辑回归模型用于检验以未接受HHC而出院回家作为参照组时，出院后接受HHC与30天再入院之间的关联。倾向得分匹配被用作一项额外分析，以比较接受HHC出院回家的患者与未接受HHC出院回家的患者的30天再入院率。 结果：在3573例行胰腺切除术的患者中，752例（21.0%）在出院后30天内再次入院。在多变量逻辑回归模型中，出院后接受HHC是30天再入院率增加的独立预测因素（比值比=1.37；95%置信区间，1.11 - 1.69；p = 0.004）。使用倾向得分匹配法，接受HHC的患者与未接受HHC出院回家的患者相比，30天再入院率显著增加（24.3%对19.8%；p < 0.001）。通过单变量比较，出院后接受HHC的患者与未接受HHC出院回家的患者相比，非严重再入院率显著增加（19.2%对13.9%；p < 0.001），但严重再入院率无显著差异（6.4%对4.7%；p = 0.08）。在多变量逻辑回归模型中，排除出院到医疗机构的患者后，出院后接受HHC是增加非严重再入院的独立预测因素（比值比=1.41；95%置信区间，1.11 - 1.79；p = 0.005），但不是严重再入院的预测因素（比值比=1.31；95%置信区间，0.88 - 1.93；p = 0.18）。 结论：胰腺切除术后出院后接受HHC是30天再入院率增加的独立预测因素；具体而言，这些服务与非严重再入院率增加相关，但与严重再入院率无关。
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