Jacobs Bruce L, He Chang, Li Benjamin Y, Helfand Alex, Krishnan Naveen, Borza Tudor, Ghaferi Amir A, Hollenbeck Brent K, Helm Jonathan E, Lavieri Mariel S, Skolarus Ted A
Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan; Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.
J Surg Res. 2017 Jun 1;213:60-68. doi: 10.1016/j.jss.2017.02.017. Epub 2017 Feb 23.
The Hospital Readmissions Reduction Program reduces payments to hospitals with excess readmissions for three common medical conditions and recently extended its readmission program to surgical patients. We sought to investigate readmission intensity as measured by readmission cost for high-risk surgeries and examine predictors of higher readmission costs.
We used the Healthcare Cost and Utilization Project's State Inpatient Database to perform a retrospective cohort study of patients undergoing major chest (aortic valve replacement, coronary artery bypass grafting, lung resection) and major abdominal (abdominal aortic aneurysm repair [open approach], cystectomy, esophagectomy, pancreatectomy) surgery in 2009 and 2010. We fit a multivariable logistic regression model with generalized estimation equations to examine patient and index admission factors associated with readmission costs.
The 30-d readmission rate was 16% for major chest and 22% for major abdominal surgery (P < 0.001). Discharge to a skilled nursing facility was associated with higher readmission costs for both chest (odds ratio [OR]: 1.99; 95% confidence interval [CI]: 1.60-2.48) and abdominal surgeries (OR: 1.86; 95% CI: 1.24-2.78). Comorbidities, length of stay, and receipt of blood or imaging was associated with higher readmission costs for chest surgery patients. Readmission >3 wk after discharge was associated with lower costs among abdominal surgery patients.
Readmissions after high-risk surgery are common, affecting about one in six patients. Predictors of higher readmission costs differ among major chest and abdominal surgeries. Better identifying patients susceptible to higher readmission costs may inform future interventions to either reduce the intensity of these readmissions or eliminate them altogether.
医院再入院减少计划减少了对三种常见疾病再入院率过高的医院的支付，并于近期将再入院计划扩展至外科手术患者。我们试图通过高危手术的再入院成本来研究再入院强度，并探讨再入院成本较高的预测因素。
我们使用医疗成本和利用项目的州住院数据库，对2009年和2010年接受主要胸部手术（主动脉瓣置换术、冠状动脉搭桥术、肺切除术）和主要腹部手术（腹主动脉瘤修复术[开放手术]、膀胱切除术、食管切除术、胰腺切除术）的患者进行回顾性队列研究。我们使用广义估计方程拟合多变量逻辑回归模型，以研究与再入院成本相关的患者和首次入院因素。
主要胸部手术的30天再入院率为16%，主要腹部手术为22%（P<0.001）。转至专业护理机构与胸部手术（优势比[OR]：1.99；95%置信区间[CI]：1.60-2.48）和腹部手术（OR：1.86；95%CI：1.24-2.78）的再入院成本较高相关。合并症、住院时间以及输血或影像学检查与胸部手术患者的再入院成本较高相关。出院后再入院>3周与腹部手术患者的成本较低相关。
高危手术后再入院很常见，约六分之一的患者受影响。主要胸部和腹部手术中再入院成本较高的预测因素有所不同。更好地识别易出现较高再入院成本的患者，可能为未来降低这些再入院强度或完全消除再入院的干预措施提供依据。
