Dziegielewski Peter T, Boyce Brian, Manning Amy, Agrawal Amit, Old Matthew, Ozer Enver, Teknos Theodoros N
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.
Head Neck. 2016 Apr;38 Suppl 1:E502-10. doi: 10.1002/hed.24030. Epub 2015 Aug 25.
Health care metrics, such as readmission rates, are being scrutinized to improve quality and decrease cost of care. The purpose of this study was to determine the rate, predictors, and costs of 30-day unplanned readmissions (30dURs) in patients who undergo head and neck surgery.
All patients undergoing head and neck surgery at the Ohio State University from July 1, 2011, to June 30, 2012, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30dURs.
\Six hundred seven patients underwent 660 operations. Forty-eight cases (7.3%) had a 30dUR. Significant independent risk factors for readmissions included: coronary artery disease (odds ratio [OR] = 2.80; confidence interval [CI] = 1.3-5.9), chronic renal failure (OR = 3.56; CI = 1.5-8.5), not attending the preoperative clinic (OR = 2.74; CI = 1.2-6.3), length of stay (LOS) >5 days (OR = 3.19; CI = 1.6-6.5), and presence of a gastrostomy tube (OR = 2.75; CI = 1.3-5.8).The total cost of 30dURs was $1.68 million.
The 30dURs in patients who undergo head and neck surgery can be low, but costly. Identifying patients at risk for 30dUR will help develop preventative strategies. © 2015 Wiley Periodicals, Inc. Head Neck 38: E502-E510, 2016.
诸如再入院率等医疗保健指标正受到严格审查，以提高医疗质量并降低医疗成本。本研究的目的是确定接受头颈外科手术患者的30天非计划再入院率、预测因素及成本。
回顾性分析2011年7月1日至2012年6月30日在俄亥俄州立大学接受头颈外科手术的所有患者。进行单因素和多因素逻辑回归分析以确定30天非计划再入院的危险因素。
607例患者接受了660次手术。48例（7.3%）发生了30天非计划再入院。再入院的显著独立危险因素包括：冠状动脉疾病（比值比[OR]=2.80；置信区间[CI]=1.3 - 5.9）、慢性肾衰竭（OR = 3.56；CI = 1.5 - 8.5）、未参加术前门诊（OR = 2.74；CI = 1.2 - 6.3）、住院时间（LOS）>5天（OR = 3.19；CI = 1.6 - 6.5）以及存在胃造瘘管（OR = 2.75；CI = 1.3 - 5.8）。30天非计划再入院的总成本为168万美元。
接受头颈外科手术患者的30天非计划再入院率可能较低，但成本高昂。识别有30天非计划再入院风险的患者将有助于制定预防策略。©2015威利期刊公司。《头颈》38：E502 - E510，2016。
