Dasenbrock Hormuzdiyar H, Angriman Frederico, Smith Timothy R, Gormley William B, Frerichs Kai U, Aziz-Sultan M Ali, Du Rose
From the Cushing Neurosurgical Outcomes Center, Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (H.H.D., T.R.S., W.B.G., K.U.F., M.A.A.-S., R.D.); and T. H. Chan School of Public Health, Harvard University, Boston, MA (H.H.D., F.A.).
Stroke. 2017 Sep;48(9):2383-2390. doi: 10.1161/STROKEAHA.117.016702. Epub 2017 Jul 28.
The goal of this nationwide study is to evaluate the suitability of readmission as a quality indicator in the aneurysmal subarachnoid hemorrhage (SAH) population.
Patients with aneurysmal SAH were extracted from the Nationwide Readmission Database (2013). Multivariable Cox proportional hazard regression was used to evaluate predictors of a 30-day readmission, and multivariable linear regression was used to analyze the association of hospital readmission rates with hospital mortality rates. Predictors screened included patient demographics, comorbidities, severity of SAH, complications from the SAH hospitalization, and hospital characteristics.
The 30-day readmission rate was 10.2% (n=346) among the 3387 patients evaluated, and the most common reasons for readmission were neurological, hydrocephalus, infectious, and venous thromboembolic complications. Greater number of comorbidities, increased severity of SAH, and discharge disposition other than to home were independent predictors of readmission (≤0.03). Although hydrocephalus during the SAH hospitalization was associated with readmission for the same diagnosis, other readmissions were not associated with having sustained the same complication during the SAH hospitalization. Hospital mortality rate was inversely associated with hospital SAH volume (=0.03) but not significantly associated with hospital readmission rate; hospital SAH volume was also not associated with SAH readmissions.
In this national analysis, readmission was primarily attributable to new medical complications in patients with greater comorbidities and severity of SAH rather than exacerbation of complications from the SAH hospitalization. Additionally, hospital readmission rates did not correlate with other established quality metrics. Therefore, readmission may be a suboptimal quality indicator in the SAH population.
这项全国性研究的目的是评估再入院作为动脉瘤性蛛网膜下腔出血（SAH）患者质量指标的适用性。
从全国再入院数据库（2013年）中提取动脉瘤性SAH患者。采用多变量Cox比例风险回归评估30天再入院的预测因素，采用多变量线性回归分析医院再入院率与医院死亡率之间的关联。筛选的预测因素包括患者人口统计学特征、合并症、SAH严重程度、SAH住院并发症以及医院特征。
在3387例接受评估的患者中，30天再入院率为10.2%（n = 346），再入院的最常见原因是神经、脑积水、感染和静脉血栓栓塞并发症。合并症数量较多、SAH严重程度增加以及出院处置非回家是再入院的独立预测因素（P≤0.03）。虽然SAH住院期间的脑积水与因相同诊断再入院有关，但其他再入院与SAH住院期间发生相同并发症无关。医院死亡率与医院SAH病例数呈负相关（P = 0.03），但与医院再入院率无显著相关性；医院SAH病例数也与SAH再入院无关。
在这项全国性分析中，再入院主要归因于合并症较多且SAH严重程度较高的患者出现的新的医疗并发症，而非SAH住院并发症的加重。此外，医院再入院率与其他既定质量指标不相关。因此，再入院可能不是SAH患者的最佳质量指标。
