Schmidt Carl R, Hefner Jennifer, McAlearney Ann S, Graham Lisa, Johnson Kristen, Moffatt-Bruce Susan, Huerta Timothy, Pawlik Timothy M, White Susan
Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio.
James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.
J Surg Oncol. 2018 May;117(6):1113-1118. doi: 10.1002/jso.24968. Epub 2018 Feb 26.
Hospital readmissions among cancer patients are common. While several models estimating readmission risk exist, models specific for cancer patients are lacking.
A logistic regression model estimating risk of unplanned 30-day readmission was developed using inpatient admission data from a 2-year period (n = 18 782) at a tertiary cancer hospital. Readmission risk estimates derived from the model were then calculated prospectively over a 10-month period (n = 8616 admissions) and compared with actual incidence of readmission.
There were 2478 (13.2%) unplanned readmissions. Model factors associated with readmission included: emergency department visit within 30 days, >1 admission within 60 days, non-surgical admission, solid malignancy, gastrointestinal cancer, emergency admission, length of stay >5 days, abnormal sodium, hemoglobin, or white blood cell count. The c-statistic for the model was 0.70. During the 10-month prospective evaluation, estimates of readmission from the model were associated with higher actual readmission incidence from 20.7% for the highest risk category to 9.6% for the lowest.
An unplanned readmission risk model developed specifically for cancer patients performs well when validated prospectively. The specificity of the model for cancer patients, EMR incorporation, and prospective validation justify use of the model in future studies designed to reduce and prevent readmissions.
癌症患者再次入院的情况很常见。虽然存在几种估计再入院风险的模型，但缺乏针对癌症患者的特定模型。
利用一家三级癌症医院两年期间（n = 18782）的住院患者入院数据，开发了一个估计30天非计划再入院风险的逻辑回归模型。然后，在10个月期间（n = 8616次入院）前瞻性地计算该模型得出的再入院风险估计值，并与实际再入院发生率进行比较。
有2478例（13.2%）非计划再入院。与再入院相关的模型因素包括：30天内急诊就诊、60天内>1次入院、非手术入院、实体恶性肿瘤、胃肠道癌症、急诊入院、住院时间>5天、钠、血红蛋白或白细胞计数异常。该模型的c统计量为0.70。在10个月的前瞻性评估期间，该模型的再入院估计值与实际再入院发生率较高相关，从最高风险类别中的20.7%到最低风险类别中的9.6%。
专门为癌症患者开发的非计划再入院风险模型在前瞻性验证时表现良好。该模型对癌症患者的特异性、电子病历纳入以及前瞻性验证证明了该模型在未来旨在减少和预防再入院的研究中的应用价值。
