Adogwa Owoicho, Elsamadicy Aladine A, Han Jing, Karikari Isaac O, Cheng Joseph, Bagley Carlos A
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
World Neurosurg. 2017 Jan;97:518-522. doi: 10.1016/j.wneu.2016.07.032. Epub 2016 Jul 27.
Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery, and more than one-third within 90 days; however, there is a paucity of data about the cause of early readmissions in elderly patients after elective spine surgery.
A total of 500 elderly patients (>65 years old) undergoing elective spine surgery at a major academic hospital were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay.
A total of 50 (10%) unplanned early readmissions were identified. The mean ± SD age was 72.54 ± 5.84 years. The mean ± SD number of days from discharge to readmission was 11.02 ± 7.25 days, and the average length of hospital stay for the readmissions was 7.7 days. The majority of patients that were readmitted presented to the emergency department from home (46%), whereas 38% were readmitted from a skilled nursing facility. The most common causes for readmission were infection or a concern for infection (42%) and pain (14%), with 32% of readmissions requiring a return to the operating room.
Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission.
脊柱手术后的早期再入院被用作医疗质量的一个指标。五分之一的患者在脊柱手术后30天内再次住院，超过三分之一在90天内再次住院；然而，关于择期脊柱手术后老年患者早期再入院原因的数据却很匮乏。
本研究纳入了一家大型学术医院500例接受择期脊柱手术的老年患者（年龄>65岁）。我们确定了出院后30天内所有非计划内的再入院情况。非计划内再入院被定义为由手术或非手术并发症导致。查阅患者记录以确定再入院原因和住院时间。
共确定了50例（10%）非计划内的早期再入院患者。平均年龄±标准差为72.54±5.84岁。从出院到再入院的平均天数±标准差为11.02±7.25天，再入院患者的平均住院时间为7.7天。大多数再入院患者是从家中被送往急诊科（46%），而38%是从专业护理机构再次入院。再入院最常见的原因是感染或疑似感染（42%）和疼痛（14%），32%的再入院患者需要返回手术室。
我们的研究表明，在接受择期脊柱手术的老年患者中，感染或疑似感染、疼痛和精神状态改变是计划外再入院最常见的主要原因。
