子宫切除术后30天再入院的相关因素。
Factors associated with 30-day hospital readmission after hysterectomy.
作者信息
Dessources Kimberly, Hou June Y, Tergas Ana I, Burke William M, Ananth Cande V, Prendergast Eri, Chen Ling, Neugut Alfred I, Hershman Dawn L, Wright Jason D
机构信息
Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York; and the Department of Obstetrics and Gynecology, University of California-Los Angeles, Los Angeles, California.
出版信息
Obstet Gynecol. 2015 Feb;125(2):461-470. doi: 10.1097/AOG.0000000000000623.
OBJECTIVE
To analyze factors associated with 30-day readmission among women who underwent hysterectomy for uterine cancer and benign indications.
METHODS
We used the National Surgical Quality Improvement Project database to perform a cohort study of women who underwent hysterectomy from 2011 to 2012. Patients were stratified by surgical indication (uterine cancer or benign indications). Multivariable logistic regression models were constructed to determine factors associated with 30-day readmission. Model fit statistics were used to evaluate the importance of demographic factors, preoperative comorbidities, and postoperative complications on readmission.
RESULTS
The rate of 30-day readmission was 6.1% among 4,725 women with uterine cancer and 3.4% after hysterectomy for benign gynecologic disease in 36,471 patients. In a series of multivariable models, postoperative complications including wound complications, infections, and pulmonary emboli and myocardial infarctions were the factors most strongly associated with readmission. Compared with women without a complication, complications increased the readmission rate from 2.5 to 20.3% for women with uterine cancer and from 1.5 to 15.1% for those without cancer. Among women with uterine cancer, postoperative complications explained 34.3% of the variance in readmission compared with 5.9% for demographic factors and 2.2% for preoperative comorbidities. For patients with benign diseases, complications accounted for 32.1%, preoperative conditions 1.2%, and demographic factors 2.5% of the variance in readmission.
CONCLUSION
Efforts to reduce readmission should be directed at initiatives to reduce complications and improve the care of women who experience a complication.
目的
分析因子宫癌和良性指征接受子宫切除术的女性患者30天再入院的相关因素。
方法
我们使用国家外科质量改进项目数据库，对2011年至2012年接受子宫切除术的女性进行队列研究。患者按手术指征（子宫癌或良性指征）分层。构建多变量逻辑回归模型以确定与30天再入院相关的因素。模型拟合统计量用于评估人口统计学因素、术前合并症和术后并发症对再入院的重要性。
结果
4725例子宫癌女性患者的30天再入院率为6.1%，36471例因良性妇科疾病接受子宫切除术的患者中这一比例为3.4%。在一系列多变量模型中，术后并发症包括伤口并发症、感染、肺栓塞和心肌梗死是与再入院最密切相关的因素。与无并发症的女性相比，并发症使子宫癌女性的再入院率从2.5%升至20.3%，非癌症女性从1.5%升至15.1%。在子宫癌女性中，术后并发症解释了再入院差异的34.3%，而人口统计学因素为5.9%，术前合并症为2.2%。对于良性疾病患者，并发症占再入院差异的32.1%，术前状况占1.2%，人口统计学因素占2.5%。
结论
降低再入院率的努力应针对减少并发症的举措，并改善出现并发症的女性的护理。
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