Yarbrough Chester K, Gamble Paul G, Burhan Janjua Muhammad, Tang Mengxuan, Ghenbot Rahel, Zhang Andrew J, Juknis Neringa, Hawasli Ammar H, Kelly Michael P, Ray Wilson Z
Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA -
Washington University School of Medicine, St. Louis, MO, USA.
J Neurosurg Sci. 2018 Jun;62(3):265-270. doi: 10.23736/S0390-5616.16.03664-X. Epub 2016 May 6.
Recent studies in other fields have suggested that healthcare on the weekend may have worse outcomes. In particular, patients with stroke and acute cardiovascular events have shown worse outcomes with weekend treatment. It is unclear whether this extends to patients with spinal cord injury. This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury.
A total of 795 consecutive patients over an 11-year period were analyzed. After excluding patients with chronic spinal cord injury and surgical care at an outside hospital, 745 patients remained. The primary outcome measure evaluated was 30-day readmission. Secondary measures include perioperative complications, readmission rate when discharged on the weekend, and the effect of race and insurance status on readmission rate. Univariate and multivariate analysis were utilized to evaluate the covariates collected. The χ2 test, Fisher's exact test, and linear and logistic regression methods were utilized for statistical analysis.
A total of 745 patients were analyzed after exclusions. Payer status did not affect length of stay, ICU length of stay, or perioperative complications. Neither weekend admission nor weekend operation affected length of stay, ICU length of stay, or readmission by 30 days. Patients undergoing weekend surgical treatment had lower perioperative complication rates (2.2% vs. 6.5% on weekday, P<0.01). Discharge on the weekend was associated with a significantly lower rate of readmission by 30 days (OR=0.07, 95% CI: 0.009-0.525, P<0.005). Payer status was associated with 30-day readmission (P<0.005). Patients with Medicare (20.8%) and Medicaid (20.1%) showed higher rates of readmission than patients with other payers. 21.1% of African-American patients were readmitted, versus 10.2% of other patients (Odds ratio: 2.2, 95% confidence interval 1.36-3.27, P<0.001). Correcting for payer status lessened but did not eliminate the effect of race on readmission.
Weekend admission did not increase perioperative complications or hospital length of stay. After discharge, patients with Medicaid and Medicare show higher rates of 30-day readmission, as do African-American patients. The effect of race on readmission is multifactorial, and may partially explained by the increased rate of Medicaid coverage in African-Americans in our institutions catchment area.
其他领域的近期研究表明，周末的医疗保健可能会有更差的结果。特别是，中风和急性心血管事件患者在周末接受治疗时预后更差。目前尚不清楚这是否也适用于脊髓损伤患者。本研究旨在评估脊髓损伤首次住院后再入院的相关因素。
对11年间共795例连续患者进行分析。排除慢性脊髓损伤患者和在外部医院接受手术治疗的患者后，剩余745例患者。评估的主要结局指标是30天再入院率。次要指标包括围手术期并发症、周末出院时的再入院率，以及种族和保险状况对再入院率的影响。采用单因素和多因素分析来评估所收集的协变量。使用χ2检验、Fisher精确检验以及线性和逻辑回归方法进行统计分析。
排除后共分析了745例患者。支付者状态不影响住院时间、重症监护病房住院时间或围手术期并发症。周末入院和周末手术均不影响住院时间、重症监护病房住院时间或30天内的再入院情况。接受周末手术治疗的患者围手术期并发症发生率较低（2.2% 对比工作日的6.5%，P<0.01）。周末出院与30天再入院率显著降低相关（比值比=0.07，95%置信区间：0.009 - 0.525，P<0.005）。支付者状态与30天再入院相关（P<0.005）。医疗保险（20.8%）和医疗补助（20.1%）患者的再入院率高于其他支付者的患者。21.1%的非裔美国患者再次入院，而其他患者为10.2%（比值比：2.2，95%置信区间1.36 - 3.27，P<0.001）。校正支付者状态后，种族对再入院的影响有所减轻，但并未消除。
周末入院并未增加围手术期并发症或住院时间。出院后，医疗补助和医疗保险患者的30天再入院率较高，非裔美国患者也是如此。种族对再入院的影响是多因素的，可能部分原因是我们机构服务区域内非裔美国人的医疗补助覆盖率增加。
