Fish Daniel R, Mancuso Carol A, Garcia-Aguilar Julio E, Lee Sang W, Nash Garrett M, Sonoda Toyooki, Charlson Mary E, Temple Larissa K
*Memorial Sloan Kettering Cancer Center, New York, NY †Weill Cornell Medical College, New York, NY.
Ann Surg. 2017 Feb;265(2):379-387. doi: 10.1097/SLA.0000000000001683.
To evaluate causes and predictors of readmission after new ileostomy creation.
New ileostomates have been reported to have higher readmission rates compared with other surgical patients, but data on predictors are limited.
A total of 1114 records at 2 associated hospitals were reviewed to identify adults undergoing their first ileostomy. Primary outcome was readmission within 60 days of surgery. Multiple logistic regression was used to identify independent predictors; area under the receiver-operator characteristic curves (AUC) were used to evaluate age-stratified models in secondary analysis.
In all, 407 patients underwent new ileostomy; 58% had cancer, 31% IBD; 49% underwent LAR, 27% colectomy, and 14% proctocolectomy. Median length of stay was 8 days. Among the patients, 39% returned to hospital, and 28% were readmitted (n = 113) at a median of 12 days postdischarge. The most common causes of readmission were dehydration (42%), intraperitoneal infections (33%), and extraperitoneal infections (29%). Dehydration was associated with later, longer, and repeated readmission. Independent significant predictors of readmission were Clavien-Dindo complication grade 3 to 4 [odds ratio (OR) 6.7], Charlson comorbidity index (OR 1.4 per point), and loop stoma (OR 2.2); longer length of stay (OR 0.5) and age 65 years or older (OR 0.4) were protective. Cohort stratification above or below age 65 revealed that older patient readmissions were more predictable (AUC 0.84) with more preventable causes, whereas younger patient readmissions were difficult to predict or prevent (AUC 0.65).
Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length of stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.
评估新造回肠造口术后再入院的原因及预测因素。
据报道，与其他手术患者相比，新造回肠造口患者的再入院率更高，但关于预测因素的数据有限。
回顾了两家相关医院的1114份记录，以确定接受首次回肠造口术的成年人。主要结局为术后60天内再入院。采用多因素逻辑回归分析确定独立预测因素；在二次分析中，使用受试者工作特征曲线下面积（AUC）评估年龄分层模型。
共有407例患者接受了新的回肠造口术；58%患有癌症，31%患有炎症性肠病（IBD）；49%接受了低位前切除术（LAR），27%接受了结肠切除术，14%接受了直肠结肠切除术。中位住院时间为8天。在这些患者中，39%返回医院，28%（n = 113）在出院后中位12天再次入院。再入院最常见的原因是脱水（42%）、腹腔内感染（33%）和腹腔外感染（29%）。脱水与较晚、较长时间和反复再入院有关。再入院的独立显著预测因素为Clavien-Dindo并发症分级3至4级[比值比（OR）6.7]、Charlson合并症指数（每增加1分OR为1.4）和袢式造口（OR 2.2）；住院时间较长（OR 0.5）和年龄65岁及以上（OR 0.4）具有保护作用。65岁及以上或以下的队列分层显示，老年患者再入院更具可预测性（AUC 0.84），且可预防的原因更多，而年轻患者再入院难以预测或预防（AUC 0.65）。
再入院最常见的原因是脱水，其预测因素为严重并发症、合并症负担、袢式造口、较短的住院时间和年龄。老年患者的再入院更容易预测，是改善的重要目标。
