Harel Ziv, Wald Ron, McArthur Eric, Chertow Glenn M, Harel Shai, Gruneir Andrea, Fischer Hadas D, Garg Amit X, Perl Jeffrey, Nash Danielle M, Silver Samuel, Bell Chaim M
Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
J Am Soc Nephrol. 2015 Dec;26(12):3141-50. doi: 10.1681/ASN.2014060614. Epub 2015 Apr 8.
Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs.
对于接受维持性中心（门诊）血液透析的患者，出院后的临床结局定义尚不明确。为了描述这些患者在急性住院出院后30天内再次住院、就诊于急诊科或死亡的比例及特征，我们对2003年1月1日至2011年12月31日期间从加拿大安大略省157家急性护理医院出院的所有接受维持性中心血液透析的成年患者进行了一项基于人群的研究。对于有多次住院经历的患者，我们随机选择一次住院作为索引住院。在最终队列纳入的11177例患者中，1926例（17%）再次住院，2971例（27%）在急诊科接受治疗，840例（7.5%）在出院后30天内死亡。2型糖尿病并发症是再次住院最常见的原因，而心力衰竭是就诊于急诊科最常见的原因。在使用特定病因的Cox比例风险模型进行的多变量分析中，以下特征与30天内再次住院相关：年龄较大、前6个月的住院次数、前6个月的急诊科就诊次数、较高的Charlson合并症指数评分以及索引住院期间接受机械通气。因此，很大一部分接受维持性中心血液透析的患者在急性住院后30天内会再次入院或就诊于急诊室。关注改善从住院环境到门诊透析单元的护理过渡可能会改善结局并降低医疗成本。
