Hansen L S, Hjortdal V E, Jakobsen C-J
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.
Department of Cardiothoracic Surgery, Aarhus University Hospital, Aarhus N, Denmark.
Acta Anaesthesiol Scand. 2016 Apr;60(4):441-9. doi: 10.1111/aas.12679. Epub 2016 Jan 8.
Fast-track protocols may facilitate early patient discharge from the site of surgery through the implementation of more expedient pathways. However, costs may merely be shifted towards other parts of the health care system. We aimed to investigate the consequence of patient transfers on overall hospitalisation, follow-up and readmission rate after cardiac surgery.
A single-centre descriptive cohort study using prospectively entered registry data. The study included 4,515 patients who underwent cardiac surgery at Aarhus University Hospital during the period 1 April 2006 to 31 December 2012. Patients were grouped and analysed based on type of discharge: Directly from site of surgery or after transfer to a regional hospital. The cohort was obtained from the Western Denmark Heart Registry and matched to the Danish National Hospital Register.
Median overall length of stay was 9 days (7.0;14.4). Transferred patients had longer length of stay, median difference of 2.0 days, p < 0.001. Time to first outpatient consultation was 41(30;58) days in transferred patients vs. 45(29;74) days, p < 0.001. 18.6% was readmitted within 30 days. Mean time to readmission was 18.4 ± 6.4 days. Median length of readmission was 3(1,6) days. There was no difference in readmissions between groups. Leading cause of readmission was cardiovascular disease with 48%.
Transfer of patients does not overtly reduce health care costs, but overall LOS and time to first outpatient consultation are substantially longer in patients transferred to secondary hospitals than in patients discharged directly. Readmission rate is high during the month after surgery, but with no difference between groups.
快速康复方案可能通过实施更便捷的途径促进患者早日从手术地点出院。然而，成本可能只是转移到了医疗保健系统的其他部分。我们旨在研究心脏手术后患者转院对总体住院时间、随访及再入院率的影响。
一项单中心描述性队列研究，使用前瞻性录入的登记数据。该研究纳入了2006年4月1日至2012年12月31日期间在奥胡斯大学医院接受心脏手术的4515例患者。根据出院类型对患者进行分组并分析：直接从手术地点出院或转至地区医院后出院。该队列数据来自丹麦西部心脏登记处，并与丹麦国家医院登记处进行匹配。
总体住院时间中位数为9天（7.0；14.4）。转院患者的住院时间更长，中位数差异为2.0天，p<0.001。转院患者首次门诊咨询时间为41（30；58）天，而非转院患者为45（29；74）天，p<0.001。18.6%的患者在30天内再次入院。再入院平均时间为18.4±6.4天。再入院时间中位数为3（1，6）天。两组之间再入院率无差异。再入院的主要原因是心血管疾病，占48%。
患者转院并没有明显降低医疗成本，但转至二级医院的患者总体住院时间和首次门诊咨询时间比直接出院的患者长得多。术后第一个月再入院率较高，但两组之间无差异。
