Bliss Lindsay A, Maguire Lillias H, Chau Zeling, Yang Catherine J, Nagle Deborah A, Chan Andrew T, Tseng Jennifer F
1 Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts 2 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 3 Department of Surgery, UMass Memorial Medical Center, Worcester, Massachusetts 4 Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 5 Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 6 Division of Surgical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dis Colon Rectum. 2015 Dec;58(12):1164-73. doi: 10.1097/DCR.0000000000000433.
Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6% to 25% of patients are readmitted after colorectal surgery.
The aim of this study is to define the predictors and costs of readmission following colorectal surgery.
This is a retrospective cohort study of patients undergoing elective and nonelective colectomy and/or proctectomy in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007 to 2011. Readmission is defined as inpatient admission within 30 days of discharge. Univariate analyses were performed of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis was performed by logistic regression. Sensitivity analysis of nonemergent admissions was conducted.
This study was conducted in Florida acute-care hospitals.
Patients undergoing colectomy and proctectomy from 2007 to 2011 were included.
INTERVENTION(S): There were no interventions.
MAIN OUTCOME MEASURE(S): The primary outcomes measured were readmission and the cost of readmission.
A total of 93,913 patients underwent colectomy; 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6%-14.2%, trend p = 0.1585). After multivariate adjustment, patient factors associated with readmission included nonwhite race, age <65, and a diagnosis code other than neoplasm or diverticular disease (p < 0.0001). Patients with Medicare or Medicaid were more likely to be readmitted than those with private insurance (p < 0.0001). Patients with longer index admissions, those with stomas, and those undergoing all procedures other than sigmoid or transverse colectomy were more likely to be readmitted (p < 0.0001). High-volume hospitals had higher rates of readmission (p < 0.0001). The most common reason for readmission was infection (32.9%). Median cost of readmission care was $7030 (intraquartile range, $4220-$13,247). Fistulas caused the most costly readmissions ($15,174; intraquartile range, $6725-$26,660).
Administrative data and retrospective design were limitations of this study.
Readmissions rates after colorectal surgery remain common and costly. Nonprivate insurance, IBD, and high hospital volume are significantly associated with readmission.
再入院率是衡量手术质量的指标，也是临床和监管审查的对象。尽管为提高质量和控制成本做出了越来越多的努力，但结直肠手术后仍有6%至25%的患者再次入院。
本研究的目的是确定结直肠手术后再入院的预测因素和成本。
这是一项对2007年至2011年佛罗里达州医疗保健成本与利用项目住院数据库中接受择期和非择期结肠切除术和/或直肠切除术患者的回顾性队列研究。再入院定义为出院后30天内再次住院。对性别、年龄、埃利克斯豪泽评分、种族、保险类型、手术、适应症、再入院诊断、成本和住院时间进行单因素分析。通过逻辑回归进行多因素分析。对非急诊入院进行敏感性分析。
本研究在佛罗里达州的急症护理医院进行。
纳入2007年至2011年接受结肠切除术和直肠切除术的患者。
无干预措施。
主要观察指标为再入院情况和再入院成本。
共有93913例患者接受了结肠切除术；14.7%的患者在30天内再次入院。2007年至2011年，再入院率保持稳定（14.6%-14.2%，趋势p = 0.1585）。多因素调整后，与再入院相关的患者因素包括非白人种族、年龄<65岁以及肿瘤或憩室病以外的诊断代码（p < 0.0001）。医疗保险或医疗补助患者比私人保险患者更有可能再次入院（p < 0.0001）。首次入院时间较长的患者、有造口的患者以及接受乙状结肠或横结肠切除术以外所有手术 procedures的患者更有可能再次入院（p < 0.0001）。高容量医院的再入院率更高（p < 0.0001）。再入院最常见的原因是感染（32.9%）。再入院护理的中位数成本为7030美元（四分位间距，4220美元至13247美元）。瘘管导致的再入院成本最高（15174美元；四分位间距，6725美元至26660美元）。
行政数据和回顾性设计是本研究的局限性。
结直肠手术后再入院率仍然很常见且成本高昂。非私人保险、炎症性肠病和高医院容量与再入院显著相关。
