Kim Yuhree, Gani Faiz, Canner Joseph K, Margonis Georgios A, Makary Martin A, Schneider Eric B, Pawlik Timothy M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Surgery. 2016 Jul;160(1):178-190. doi: 10.1016/j.surg.2016.01.025. Epub 2016 Apr 14.
Most studies report data only on readmission within 30 days of discharge from the same hospital following a single procedure. We sought to define the incidence of early versus late hospital readmission among patients undergoing multiple major operative procedures.
Patients were identified using the MarketScan database from 2010-2012. Multivariable logistic regression analysis was performed to identify factors associated with early (≤30 days) versus late readmission (31-90 days) among patients who underwent multiple operative procedures.
A total of 194,111 patients were identified of whom 63.2% (n = 122,660) underwent an abdominal procedure (esophagectomy, pancreatectomy, hepatectomy, colectomy, lung resection, and gastrectomy), while the remaining 71,451 (36.8%) patients underwent a cardiovascular procedure (repair of abdominal aortic aneurysm, coronary-artery bypass grafting, carotid endarterectomy, and mitral/aortic valve replacement). A total of 3,444 patients underwent >1 simultaneous procedure (abdominal: 885, 0.7%; cardiovascular: 2,559, 3.6%). The overall incidence of 90-day readmission was 15.6% (n = 30,309); 9.6% of patients were readmitted early, while 6.0% of patients were readmitted late. Readmission was higher among patients undergoing multiple procedures (21.8% vs 15.5%; P < .001). On multivariable analysis, patients undergoing multiple operative procedures demonstrated a 20% greater odds of readmission compared with patients undergoing a single operative procedure (abdominal: odds ratio 1.18, 95% confidence interval 1.01-1.37; P = .03; cardiovascular: odds ratio 1.18, 95% confidence interval 1.06-1.31; P = .002). Other risk factors independently associated with increased odds for early and late readmission included a higher preoperative comorbidity, postoperative discharge with additional care, an increasing duration of stay, and the development of postoperative complications (all P < .05).
Readmission following a major operation is common, with >15% of patients being readmitted within 90 days of index discharge. Compared with patients undergoing a single operative procedure, patients undergoing multiple operative procedures demonstrated an increased risk for readmission within 90 days of discharge and were more likely to be readmitted within 30 days of index discharge.
大多数研究仅报告单次手术后从同一家医院出院后30天内再入院的数据。我们试图确定接受多次大手术的患者早期与晚期再入院的发生率。
使用2010 - 2012年的MarketScan数据库识别患者。对接受多次手术的患者进行多变量逻辑回归分析，以确定与早期（≤30天）和晚期再入院（31 - 90天）相关的因素。
共识别出194,111例患者，其中63.2%（n = 122,660）接受了腹部手术（食管切除术、胰腺切除术、肝切除术、结肠切除术、肺切除术和胃切除术），其余71,451例（36.8%）患者接受了心血管手术（腹主动脉瘤修复术、冠状动脉搭桥术、颈动脉内膜切除术和二尖瓣/主动脉瓣置换术）。共有3,444例患者同时接受了>1次手术（腹部：885例，0.7%；心血管：2,559例，3.6%）。90天再入院的总体发生率为15.6%（n = 30,309）；9.6%的患者早期再入院，6.0%的患者晚期再入院。接受多次手术的患者再入院率更高（21.8%对15.5%；P <.001）。多变量分析显示，与接受单次手术的患者相比，接受多次手术的患者再入院几率高20%（腹部：比值比1.18，95%置信区间1.01 - 1.37；P = 0.03；心血管：比值比1.18，95%置信区间1.06 - 1.31；P = 0.002）。与早期和晚期再入院几率增加独立相关的其他危险因素包括术前合并症较高、术后出院时需要额外护理、住院时间延长以及术后并发症的发生（所有P <.05）。
大手术后再入院很常见，超过15%的患者在首次出院后90天内再入院。与接受单次手术的患者相比，接受多次手术的患者在出院后90天内再入院的风险增加，并且更有可能在首次出院后30天内再入院。
