Kelly Kristin N, Iannuzzi James C, Aquina Christopher T, Probst Christian P, Noyes Katia, Monson John R T, Fleming Fergal J
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave., Box SURG, Rochester, NY, 14642, USA,
J Gastrointest Surg. 2015 Mar;19(3):418-27; discussion 427-8. doi: 10.1007/s11605-014-2718-7. Epub 2014 Dec 18.
There is a growing interest in surgery regarding the balance between appropriate hospital length of stay (LOS) and prevention of unnecessary readmissions. This study examines the relationship between postoperative LOS and unplanned readmission after colorectal resection, exploring whether patients discharged earlier have different readmission risk profiles.
Patients undergoing colorectal resection were selected by Common Procedural Terminology (CPT) code from the 2012 ACS National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified by LOS quartile. Kaplan-Meier analysis was used to examine characteristics associated with 30-day unplanned readmission. Factors with a p < 0.1 were included in the Cox proportional hazards model. Subsequently, chi-square analysis compared LOS, patient, and perioperative factors with the primary reason for readmission. Factors with a p < 0.2 were included in a multivariable logistic regression for each readmission reason.
For 33,033 patients undergoing colorectal resection, the overall 30-day unplanned readmission rate was 11 %. After adjusting for patient and perioperative factors, a postoperative LOS ≥8 days was associated with a 55 % increase in the relative hazard of readmission. Patients with a ≤3-day LOS were more likely to be readmitted with ileus/obstruction (odds ratio (OR): 1.8, p = 0.001) and pain (OR: 2.2, p = 0.007). LOS was not significantly associated with readmission for intraabdominal infection or medical complications.
Patients with longer LOS and complicated hospital courses continue to be high risk post-discharge, while straightforward early discharges have a different readmission risk profile. More targeted readmission prevention strategies are critical to focusing resource utilization for colorectal surgery patients.
外科手术领域对于合适的住院时长（LOS）与预防不必要的再入院之间的平衡愈发关注。本研究探讨结直肠切除术后的住院时长与非计划再入院之间的关系，探究更早出院的患者是否具有不同的再入院风险特征。
通过通用程序术语（CPT）编码从2012年美国外科医师学会国家外科质量改进计划（NSQIP）数据库中选取接受结直肠切除术的患者。患者按住院时长四分位数分层。采用Kaplan-Meier分析来检查与30天非计划再入院相关的特征。p < 0.1的因素纳入Cox比例风险模型。随后，进行卡方分析，比较住院时长、患者及围手术期因素与再入院的主要原因。p < 0.2的因素针对每个再入院原因纳入多变量逻辑回归分析。
对于33033例接受结直肠切除术的患者，总体30天非计划再入院率为11%。在对患者和围手术期因素进行调整后，术后住院时长≥8天与再入院相对风险增加55%相关。住院时长≤3天的患者更有可能因肠梗阻/阻塞（比值比（OR）：1.8，p = 0.001）和疼痛（OR：2.2，p = 0.007）而再入院。住院时长与腹腔内感染或医疗并发症导致的再入院无显著关联。
住院时长较长且住院过程复杂的患者出院后仍是高风险人群，而直接的早期出院具有不同的再入院风险特征。更具针对性的再入院预防策略对于合理利用结直肠手术患者的资源至关重要。
