Dickinson Karen J, Taswell James B, Allen Mark S, Blackmon Shanda H, Nichols Francis C, Shen Robert, Wigle Dennis A, Cassivi Stephen D
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2017 Apr;103(4):1084-1091. doi: 10.1016/j.athoracsur.2016.09.065. Epub 2016 Dec 16.
Unplanned readmissions are adverse clinical events that negatively impact patients and affect the use of health care resources. Identifying risk factors that can predict readmissions might permit individualized patient management. We compiled a complete account of readmissions after all lung resections over a year to identify potentially modifiable risk factors.
All patients undergoing elective lung resection between August 1, 2013 and July 31, 2014 were contacted directly to determine whether they had been readmitted to any institution within 30 days of discharge from our service. Demographic data were supplemented from our prospectively maintained database. Follow-up was complete in 100% of patients.
Over the 12-month study period, 582 lung resections were performed. Five hundred fifty-four resections in 532 patients were performed with the thoracic surgical service as the primary service. Of these patients, 505 undergoing 521 resections consented for their data to be included in the study, and they all survived to 30 days. Mean age was 62.3 years (standard deviation [SD], 13.8 years). The male to female ratio was 265:240. Fifteen pneumonectomies, 222 lesser anatomic resections in 215 patients, and 270 nonanatomic (wedge) resections in 261 patients were performed; 14 other miscellaneous resections were performed in 14 patients. Thirty-day mortality was 1% (5 of 510 patients). There were 4 in-hospital deaths and 1 additional mortality within 30 days. Unplanned readmissions occurred in 42 patients (42 of 505 patients [8.3%])-28 (67%) at our institution and 14 (33%) at other institutions. The median interval to readmission was 14 days. Readmissions occurred in 7.3% of patients discharged home, whereas 19.4% of patients discharged to a nursing home or other facility required readmission (p = 0.041). The most common reason for readmission was respiratory complications (47%). Significant factors (p < 0.05) associated with increased risk of readmission were lower percent predicted forced expiratory volume in 1 second (FEV), longer operative time, perioperative furosemide administration, pain score of 6 or greater between 12 and 24 hours after the operation, prolonged air leakage (>5 days), blood transfusion, and discharge to a nursing home. Length of stay after lung resection was not a risk factor for unplanned readmission.
The unplanned readmission rate after lung resection for our cohort was 8.3%, with half resulting from respiratory issues. Risk factors in the preoperative, perioperative, and postoperative setting were identified that may provide opportunities for mitigating these adverse events.
非计划再次入院是不良临床事件，会对患者产生负面影响并影响医疗资源的使用。识别可预测再次入院的风险因素或许能实现个体化的患者管理。我们汇总了一年内所有肺切除术后的再次入院情况，以确定潜在的可改变风险因素。
直接联系了2013年8月1日至2014年7月31日期间接受择期肺切除术的所有患者，以确定他们在从我们科室出院后30天内是否再次入住任何机构。人口统计学数据从我们前瞻性维护的数据库中补充。100%的患者完成了随访。
在12个月的研究期间，共进行了582例肺切除术。532例患者中的554例切除术以胸外科服务作为主要服务。在这些患者中，505例接受521例切除术的患者同意将其数据纳入研究，且他们均存活至30天。平均年龄为62.3岁（标准差[SD]，13.8岁）。男女比例为265:240。进行了15例全肺切除术、215例患者中的222例较小解剖切除术以及261例患者中的270例非解剖（楔形）切除术；14例患者进行了14例其他杂项切除术。30天死亡率为1%（510例患者中的5例）。有4例住院死亡和30天内另外1例死亡。42例患者（505例患者中的42例[8.3%]）发生了非计划再次入院——28例（67%）在我们机构，14例（33%）在其他机构。再次入院的中位间隔时间为14天。出院回家的患者中有7.3%再次入院，而出院至养老院或其他机构的患者中有19.4%需要再次入院（p = 0.041）。再次入院最常见的原因是呼吸并发症（47%）。与再次入院风险增加相关的显著因素（p < 0.05）包括1秒用力呼气容积（FEV）预测值百分比降低、手术时间延长、围手术期使用速尿、术后12至24小时疼痛评分≥6分、漏气时间延长（>5天）、输血以及出院至养老院。肺切除术后的住院时间不是非计划再次入院的风险因素。
我们队列中肺切除术后的非计划再次入院率为8.3%，其中一半是由呼吸问题导致的。确定了术前、围手术期和术后的风险因素，这可能为减轻这些不良事件提供机会。
