Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Am J Surg. 2018 Apr;215(4):557-562. doi: 10.1016/j.amjsurg.2017.07.024. Epub 2017 Jul 21.
To analyze demographics and outcomes of patients focusing on 30-day readmission status and identify procedure-specific risk factors.
Patients undergoing abdominal colorectal surgery (2011-2013) were identified Demographics and outcomes including in-hospital complications were compared based on readmission status.
A total of 6637 patients were identified with a mean age of 51.2(±17.1) years. Seven hundred and seventy five(11.7%) patients were readmitted at least once within 30-day. The most common index procedures related to readmission were stoma closure (n = 127/775, 16.4%) and total colectomy (n = 105/775, 13.6%). Readmitted patients had longer length of index hospital stay (LOS)(8.2 ± 5.9 vs 7.9 ± 6.9 days,p < 0.001) and operative time(167 ± 104 vs 144 ± 95 min, p < 0.001), higher intraoperative(2% vs 1%,p = 0.04) and in-hospital complication rates(36% vs 28%,p < 0.001). Main reasons for readmissions were gastrointestinal-related causes(n = 222, 29%), small bowel obstruction (n = 133,17%), wound-related complications(n = 108,14%), and dehydration(n = 93,12%). Median readmission LOS was 4(1-71)days and 54%(n = 407) of readmissions occurred within 7 days of discharge.
Increased postoperative complications may be the main preventable underlying reason for increased risk of hospital readmission after colorectal surgery. Preventive measures to decrease complications and actions to identify high risk patients for complications would help to reduce readmissions.
分析以 30 天再入院状态为重点的患者人口统计学和结局，并确定特定于手术的风险因素。
确定 2011 年至 2013 年期间接受腹部结直肠手术的患者。根据再入院状态比较人口统计学和结局，包括住院期间并发症。
共确定 6637 例患者，平均年龄为 51.2(±17.1)岁。775 例(11.7%)患者在 30 天内至少再入院一次。与再入院相关的最常见索引手术是造口关闭(n=127/775，16.4%)和全结肠切除术(n=105/775，13.6%)。再入院患者的索引住院时间(LOS)(8.2±5.9 天 vs 7.9±6.9 天，p<0.001)和手术时间(167±104 分钟 vs 144±95 分钟，p<0.001)较长，术中(2% vs 1%，p=0.04)和住院期间并发症发生率(36% vs 28%，p<0.001)较高。再入院的主要原因是胃肠道相关原因(n=222，29%)、小肠梗阻(n=133，17%)、伤口相关并发症(n=108，14%)和脱水(n=93，12%)。再入院 LOS 的中位数为 4(1-71)天，54%(n=407)的再入院发生在出院后 7 天内。
结直肠手术后住院再入院风险增加的主要可预防潜在原因可能是术后并发症增加。减少并发症的预防措施和识别并发症高危患者的措施将有助于减少再入院。
