Hegeman Timothy W, Glorioso Thomas J, Hess Edward, Barón Anna E, Ho P Michael, Maddox Thomas M, Bradley Steven M, Burke Robert E
University of Colorado School of Medicine, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO
Colorado Cardiovascular Outcomes Research Consortium, Denver, CO VA Eastern Colorado Health Care System, Denver, CO Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Am Heart Assoc. 2016 Sep 14;5(9):e003503. doi: 10.1161/JAHA.116.003503.
Thirty-day readmission after percutaneous coronary intervention (PCI) is common, costly, and linked to poor patient outcomes. Accordingly, facility-level 30-day readmission rates have been considered as a potential quality measure. However, it is unknown whether facility-level 30-day readmission rates are associated with facility-level mortality. We sought to determine the effect of 30-day readmissions after PCI on mortality at both the patient and facility level in the Veterans Administration hospital system.
We included all patients who underwent PCI in the Veterans Administration hospital system nationally from October 2007 through August 2012, comparing all-cause mortality rates between patients with and without 30-day readmissions following PCI. Patients were then aggregated at the hospital level to evaluate the correlation between hospital-level readmission rates with hospital-level 1-year mortality rates. Among 41 069 patients undergoing PCI at 62 sites, 12.2% were readmitted within 30 days of discharge. Patients with 30-day readmission had higher risk-adjusted mortality (hazard ratio 1.53, 95% CI 1.44-1.63, P<0.0001). Facilities varied widely in 30-day readmission rates (systemwide range of 6.6-19.4%, median 11.8%, interquartile range 10.0-13.2%); however, adjusted facility-level readmission rates were not correlated with adjusted 1-year mortality rates.
Thirty-day readmissions after PCI are common and are a significant risk factor for mortality for individual patients even after robust statistical adjustment for clinical confounding. However, lack of correlation between readmission and mortality at the facility level suggests that quality improvement based on facility-level readmission rates will not modify mortality in this high-risk group.
经皮冠状动脉介入治疗（PCI）后30天再入院情况常见、费用高昂，且与患者预后不良相关。因此，机构层面的30天再入院率被视为一种潜在的质量衡量指标。然而，机构层面的30天再入院率是否与机构层面的死亡率相关尚不清楚。我们试图确定PCI后30天再入院对退伍军人事务部医院系统中患者和机构层面死亡率的影响。
我们纳入了2007年10月至2012年8月在全国退伍军人事务部医院系统接受PCI的所有患者，比较PCI后有和没有30天再入院患者的全因死亡率。然后将患者在医院层面进行汇总，以评估医院层面再入院率与医院层面1年死亡率之间的相关性。在62个地点接受PCI的41069例患者中，12.2%在出院后30天内再次入院。30天再入院的患者有更高的风险调整死亡率（风险比1.53，95%CI 1.44 - 1.63，P<0.0001）。各机构的30天再入院率差异很大（全系统范围为6.6 - 19.4%，中位数11.8%，四分位间距10.0 - 13.2%）；然而，调整后的机构层面再入院率与调整后的1年死亡率不相关。
PCI后30天再入院情况常见，即使在对临床混杂因素进行强有力的统计调整后，仍是个体患者死亡的重要危险因素。然而，机构层面再入院率与死亡率之间缺乏相关性表明，基于机构层面再入院率的质量改进不会改变这一高危群体的死亡率。
