Tinsley Andrew, Naymagon Steven, Mathers Bradley, Kingsley Michael, Sands Bruce E, Ullman Thomas A
Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center , Hershey, PA 17033 , USA.
Scand J Gastroenterol. 2015;50(9):1103-9. doi: 10.3109/00365521.2015.1020862. Epub 2015 Apr 11.
Early readmission rates are becoming an integral measure of the quality of care for hospitalized patients with chronic diseases. The incidence and predictors of early readmission in patients with inflammatory bowel disease (IBD) are uncertain. Risk factors for readmission over the first few weeks may differ from those that influence re-hospitalization at later time points. We examined the incidence and predictors of both 30-day and 90-day readmissions among ulcerative colitis (UC) patients.
A retrospective, cohort study was performed including all severe UC patients admitted to a tertiary-care hospital between January 2007 and December 2011. All-cause readmissions to the medical or surgical service within 30 and 90 days were recorded to allow the calculation of early readmission rates. We used multiple logistic regression to analyze demographic, hospital-related, general medical and IBD-specific factors as potential risk factors for readmission.
There were a total of 229 patients discharged following hospitalization for severe UC. The 30- and 90-day readmission rates were 11.7% and 20.5%, respectively. Forty-seven percent of early readmissions were for colectomy. In the 30-day analysis, only the presence of extensive colitis (odds ratio 3.59; 95% confidence interval [CI] 1.41-9.13) compared with left-sided disease was independently associated with readmission. Extensive colitis (3.09, 95% CI 1.33-7.08), albumin on admission (0.56, 0.31-0.99) and being admitted to a housestaff service (2.87, 95% CI 1.14-6.54), were independent predictors of readmission at 90 days.
Early readmission is common in IBD. Independent risk factors for early readmission included extensive colitis, admission albumin, and being admitted to a housestaff service.
早期再入院率正成为衡量慢性病住院患者护理质量的一项重要指标。炎症性肠病（IBD）患者早期再入院的发生率及预测因素尚不确定。最初几周内再入院的危险因素可能与影响后期再住院的因素不同。我们研究了溃疡性结肠炎（UC）患者30天和90天再入院的发生率及预测因素。
进行了一项回顾性队列研究，纳入2007年1月至2011年12月期间入住一家三级医疗医院的所有重度UC患者。记录30天和90天内内科或外科服务的全因再入院情况，以计算早期再入院率。我们使用多因素logistic回归分析人口统计学、医院相关、普通内科及IBD特异性因素作为再入院的潜在危险因素。
共有229例重度UC患者住院后出院。30天和90天再入院率分别为11.7%和20.5%。47%的早期再入院是因为结肠切除术。在30天分析中，与左侧病变相比，仅广泛性结肠炎（比值比3.59；95%置信区间[CI]1.41 - 9.13）与再入院独立相关。广泛性结肠炎（3.09，95%CI 1.33 - 7.08）、入院时白蛋白水平（0.56，0.31 - 0.99）以及入住住院医师服务病房（2.87，95%CI 1.14 - 6.54）是90天再入院的独立预测因素。
IBD患者早期再入院很常见。早期再入院的独立危险因素包括广泛性结肠炎、入院白蛋白水平以及入住住院医师服务病房。
