Division of Plastic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA,
Hernia. 2015 Feb;19(1):125-33. doi: 10.1007/s10029-014-1329-2. Epub 2014 Dec 16.
Institutions are now incentivized to decrease rates of preventable readmissions. The purpose of this study was to examine readmissions following open ventral hernia repair (VHR), to ultimately create a model to preoperatively identify high-risk patients.
Utilizing the 2011 and 2012 ACS-NSQIP datasets, patients undergoing open VHR were identified by CPT codes. Patients who were readmitted in 2011 within 30 days of the procedure were compared to those who were not with regard to preoperative and operative characteristics. A bootstrap analysis was performed to identify internally validated risk factors to be included in the final logistic regression, which was utilized to create a weighted model to predict the risk of readmission. This model was then validated with VHR patients in 2012.
Overall, 10,745 patients were included for model generation. Of these, 850 (7.9%) patients were readmitted within 30 days. The final bootstrap analysis demonstrated that active smoking, ASA ≥ 3, a history of bleeding disorder or anemia, long operative time, inpatient status, and concurrent panniculectomy were all independently associated with readmission following ventral hernia repair. Significant variables were assigned a weighted score, ranging from 1 to 3. Each patient was then placed into one of four cohorts according to their summed score. The internally validated model [Hernia Readmission Risk (HERR) Score] demonstrated that risk increased in a linear fashion, with the highest risk cohort having a 21% risk of 30-day readmission.
Perioperative predictors of readmission following VHR include smoking, ASA score, operative magnitude, concurrent panniculectomy, and preoperative anemia and bleeding disorders. The presented model based on these factors can aid in perioperative risk stratification for readmission.
现在，医疗机构被激励降低可预防再入院率。本研究旨在调查开放式腹疝修补术（VHR）后的再入院情况，最终建立一种模型，以便在术前识别高危患者。
利用 2011 年和 2012 年 ACS-NSQIP 数据集，通过 CPT 代码识别接受开放式 VHR 的患者。将 2011 年术后 30 天内再入院的患者与未再入院的患者进行比较，比较术前和手术特征。采用 bootstrap 分析确定内部验证的风险因素，纳入最终的逻辑回归，利用该回归建立预测再入院风险的加权模型。然后，使用 2012 年 VHR 患者对该模型进行验证。
总体而言，共纳入 10745 例患者进行模型生成。其中，850 例（7.9%）患者在术后 30 天内再入院。最终的 bootstrap 分析表明，吸烟、ASA 分级≥3、出血性疾病或贫血史、手术时间长、住院状态和同期行皮瓣切除术与 VHR 后再入院均独立相关。显著变量被赋予加权评分，范围为 1 至 3。然后根据患者的总评分将每位患者分为四组之一。该内部验证的模型[疝再入院风险（HERR）评分]表明，风险呈线性增加，风险最高的组在 30 天内再入院的风险为 21%。
VHR 后再入院的围手术期预测因素包括吸烟、ASA 评分、手术规模、同期行皮瓣切除术以及术前贫血和出血性疾病。基于这些因素的提出的模型可用于再入院的围手术期风险分层。
