Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, Pennsylvania.
Institute for Advanced Application, Geisinger Health System, Danville, Pennsylvania.
J Am Coll Cardiol. 2017 Apr 18;69(15):1897-1908. doi: 10.1016/j.jacc.2017.02.040. Epub 2017 Mar 6.
Readmissions constitute a major health care burden among critical limb ischemia (CLI) patients.
This study aimed to determine the incidence of readmission and factors affecting readmission in CLI patients.
All adult hospitalizations with a diagnosis code for CLI were included from State Inpatient Databases from Florida (2009 to 2013), New York (2010 to 2013), and California (2009 to 2011). Data were merged with the directory available from the American Hospital Association to obtain detailed information on hospital-related characteristics. Geographic and routing analysis was performed to evaluate the effect of travel time to the hospital on readmission rate.
Overall, 695,782 admissions from 212,241 patients were analyzed. Of these, 284,189 were admissions with a principal diagnosis of CLI (primary CLI admissions). All-cause readmission rates at 30 days and 6 months were 27.1% and 56.6%, respectively. The majority of these were unplanned readmissions. Unplanned readmission rates at 30 days and 6 months were 23.6% and 47.7%, respectively. The major predictors of 6-month unplanned readmissions included age, female sex, black/Hispanic race, prior amputation, Charlson comorbidity index, and need for home health care or rehabilitation facility upon discharge. Patients covered by private insurance were least likely to have a readmission compared with Medicaid/no insurance and Medicare populations. Travel time to the hospital was inversely associated with 6-month unplanned readmission rates. There was a significant interaction between travel time and major amputation as well as travel time and revascularization strategy; however, the inverse association between travel time and unplanned readmission rate was evident in all subgroups. Furthermore, length of stay during index hospitalization was directly associated with the likelihood of 6-month unplanned readmission (odds ratio for log-transformed length of stay: 2.39 [99% confidence interval: 2.31 to 2.47]).
Readmission among patients with CLI is high, the majority of them being unplanned readmissions. Several demographic, clinical, and socioeconomic factors play important roles in predicting readmissions.
再入院是 CLI 患者的主要医疗负担。
本研究旨在确定 CLI 患者的再入院发生率及影响再入院的因素。
从佛罗里达州（2009 年至 2013 年）、纽约州（2010 年至 2013 年）和加利福尼亚州（2009 年至 2011 年）的州住院患者数据库中纳入所有诊断为 CLI 的成年住院患者。将数据与美国医院协会的名录合并，以获取有关医院相关特征的详细信息。进行地理和路径分析，以评估到医院的旅行时间对再入院率的影响。
总体而言，分析了 212241 例患者的 695782 例入院。其中，284189 例为 CLI 的主要诊断（主要 CLI 入院）。30 天和 6 个月的全因再入院率分别为 27.1%和 56.6%。其中大多数为非计划性再入院。30 天和 6 个月的非计划性再入院率分别为 23.6%和 47.7%。6 个月非计划性再入院的主要预测因素包括年龄、女性、黑人和/或西班牙裔、既往截肢、Charlson 合并症指数以及出院时需要家庭保健或康复设施。与 Medicaid/无保险和 Medicare 人群相比，私人保险覆盖的患者再入院的可能性最低。到医院的旅行时间与 6 个月的非计划性再入院率呈负相关。旅行时间与主要截肢以及旅行时间与血运重建策略之间存在显著交互作用；然而，旅行时间与非计划性再入院率之间的负相关在所有亚组中均存在。此外，指数住院期间的住院时间与 6 个月非计划性再入院的可能性直接相关（对数转换住院时间的优势比：2.39[99%置信区间：2.31 至 2.47]）。
CLI 患者的再入院率很高，其中大多数为非计划性再入院。几个人口统计学、临床和社会经济因素在预测再入院方面起着重要作用。
