社区医疗保健机构中肱骨近端骨折手术治疗后的早期医院再入院率及死亡风险
Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization.
作者信息
Yian Edward, Zhou Hui, Schreiber Ariyon, Sodl Jeff, Navarro Ron, Singh Anshuman, Bezrukov Nikita
机构信息
Orthopedic Surgeon at the Anaheim Medical Center in CA.
Biostatistician for Research and Evaluation for the Southern California Permanente Medical Group in Pasadena, CA.
出版信息
Perm J. 2016 Winter;20(1):47-52. doi: 10.7812/TPP/15-065.
CONTEXT
Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles.
OBJECTIVE
To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures.
DESIGN
Retrospective cohort analysis from Kaiser Permanente Southern California Region database.
METHODS
Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes.
RESULTS
From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42-8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ≥ 10 (OR, 4.47, 95% CI = 2.54-7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05-1.19), cancer (OR 3.38, 95% CI = 1.61-7.10), 30-day readmission (OR 3.31, 95% CI = 1.34-8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40-44.17) predicted higher mortality risk.
CONCLUSION
After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality.
背景
肱骨近端骨折的手术治疗呈指数级增长。近期的医疗保健政策鼓励各医疗中心降低医院再入院率。更好地了解该人群再入院和早期死亡的风险因素，将有助于确定有利的风险效益患者特征。
目的
确定肱骨近端骨折开放手术后30天医院再入院率和1年死亡率的发生率及风险因素。
设计
对凯撒永久医疗集团南加州地区数据库进行回顾性队列分析。
方法
使用国际疾病分类第九版的诊断和手术编码，对所有手术治疗的肱骨近端骨折进行验证。收集医院再入院情况、1年死亡率以及人口统计学和医疗数据。进行逻辑回归测试以评估结果的潜在风险因素。
结果
在1387例手术患者中，30天全因再入院率为5.6%。40%的医院再入院是由手术相关原因导致的。严重肝病（比值比[OR]，3.48，95%置信区间[CI]=1.42-8.55）和LACE（住院时间、入院急症程度、合并症以及前6个月急诊科就诊次数）指数评分≥10（OR，4.47，95%CI=2.54-7.86）是多因素分析中再入院的独立风险因素。1年死亡率为4.86%。多因素分析显示住院时间（OR 1.11，95%CI=1.05-1.19）、癌症（OR 3.38，95%CI=1.61-7.10）、30天再入院（OR 3.31，95%CI=1.34-8.21）以及Charlson合并症指数大于或等于4（OR 13.94，95%CI=4.40-44.17）预示着更高的死亡风险。
结论
肱骨近端骨折开放治疗后，30天全因医院再入院率为5.6%。手术并发症占再入院的40%。严重肝病和LACE评分与术后30天再入院风险相关性最佳。住院时间、既往癌症、30天再入院情况以及Charlson合并症指数可预测1年死亡率。
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