Patterson Wendy L, Peoples Brittany D, Gesten Foster C
Office of Quality and Patient Safety, New York State Department of Health, Albany, NY.
Office of Quality and Patient Safety, New York State Department of Health, Albany, NY.
Surg Obes Relat Dis. 2015 Jul-Aug;11(4):866-72. doi: 10.1016/j.soard.2014.12.019. Epub 2014 Dec 24.
Using hospital readmissions as a quality of care measure predicates that some readmissions were preventable.
This study identifies predictors of potentially preventable readmissions (PPR) within 30 days of bariatric surgery discharge.
New York State acute care hospitals.
Adult inpatient surgical discharges, during 2012, with a principal diagnosis of overweight or obesity and a principal procedure for bariatric surgery were identified. Logistic regression was used to evaluate surgical approach, sex, age, race/ethnicity, payor, body mass index, complications and co-morbidities recorded during the surgical admission.
There were 10,448 surgeries studied for readmission of which 552 were followed by a PPR, for a statewide rate of 5.3 per 100 surgeries. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was the most common surgical approach (46.0%), then Sleeve Gastrectomy (SG) (41.3%), Laparoscopic Adjustable Gastric Band (LAGB) (8.1%), and Open Roux-en-Y Gastric Bypass (RYGB) (4.6%). RYGB had the highest PPR rate (8.8), followed by LRYGB (6.1), SG (4.3) and LAGB (3.3). Compared to LAGB, the odds of a PPR in patients with RYGB, LRYGB, and SG increased by 2.4 fold, 1.8 fold and 1.2 fold respectively. Black, non-Hispanic patients were at a greater risk of PPR (odds-ratio 2.0, P<.0001) compared to White, non-Hispanic patients while the risk of a PPR increased by 2-fold in patients with a surgical complication.
Taking all patient risk factors into account, the most significant predictors of a PPR were surgical approach, race and the presence of a surgical complication.
将医院再入院情况作为医疗质量衡量指标意味着某些再入院情况是可以预防的。
本研究确定了减肥手术后30天内潜在可预防再入院（PPR）的预测因素。
纽约州急症护理医院。
确定2012年期间主要诊断为超重或肥胖且主要手术为减肥手术的成年住院手术出院病例。采用逻辑回归分析评估手术方式、性别、年龄、种族/民族、付款人、体重指数、手术入院时记录的并发症和合并症。
共研究了10448例手术的再入院情况，其中552例出现PPR，全州每100例手术的发生率为5.3例。腹腔镜Roux-en-Y胃旁路术（LRYGB）是最常见的手术方式（46.0%），其次是袖状胃切除术（SG）（41.3%）、腹腔镜可调节胃束带术（LAGB）（8.1%）和开放式Roux-en-Y胃旁路术（RYGB）（4.6%）。RYGB的PPR发生率最高（8.8），其次是LRYGB（6.1）、SG（4.3）和LAGB（3.3）。与LAGB相比，RYGB、LRYGB和SG患者发生PPR的几率分别增加了2.4倍、1.8倍和1.2倍。与非西班牙裔白人患者相比，非西班牙裔黑人患者发生PPR的风险更高（优势比2.0，P<0.0001），而手术并发症患者发生PPR的风险增加了2倍。
综合考虑所有患者风险因素，PPR的最重要预测因素是手术方式、种族和手术并发症的存在。
