Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
J Gastrointest Surg. 2018 Jul;22(7):1221-1229. doi: 10.1007/s11605-018-3740-y. Epub 2018 Mar 22.
The relationship between the post-discharge settings and the risk of readmission has not been well examined. We sought to identify the association between discharge destinations and readmission rates after liver and pancreas surgery.
The 2013-2015 Medicare-Provider Analysis and Review (MEDPAR) database was reviewed to identify liver and pancreas surgical patients. Patients were subdivided into three groups based on discharge destination: home/self-care (HSC), home with home health assistance (HHA), and skilled nursing facility (SNF). The association between post-acute settings, readmission rates, and readmission causes was assessed.
Among 15,141 liver or pancreas surgical patients, 60% (n = 9046) were HSC, 26.9% (n = 4071) were HHA, and 13.4% (n = 2024) were SNF. Older, female patients and patients with ≥ 2 comorbidities, ≥ 2 previous admissions, an emergent index admission, an index complication, and ≥ 5-day length of stay were more likely to be discharged to HHA or SNF compared to HSC (all P < 0.001). Compared to HSC, HHA and SNF patients had a 34 and a 67% higher likelihood of 30-day readmission, respectively. The HHA and SNF settings were also associated with a 33 and a 69% higher risk of 90-day readmission. There was no association between discharge destination and readmission causes.
Among liver and pancreas surgical patients, HHA and SNF patients had a higher risk of readmission within 30 and 90 days. There was no difference in readmission causes and discharge settings. The association between discharge setting and the higher risk of readmission should be further evaluated as the healthcare system seeks to reduce readmission rates after surgery.
出院后设置与再入院风险之间的关系尚未得到充分研究。我们旨在确定肝胰手术患者出院去向与再入院率之间的关系。
回顾了 2013-2015 年 Medicare-Provider Analysis and Review（MEDPAR）数据库，以确定肝胰手术患者。根据出院去向将患者分为三组：家庭/自理（HSC）、家庭伴有家庭健康援助（HHA）和熟练护理设施（SNF）。评估了急性后环境、再入院率和再入院原因之间的关系。
在 15141 例肝或胰腺手术患者中，60%（n=9046）为 HSC，26.9%（n=4071）为 HHA，13.4%（n=2024）为 SNF。年龄较大、女性患者和伴有≥2 种合并症、≥2 次既往住院、急症指数入院、指数并发症和≥5 天住院时间的患者更有可能被送往 HHA 或 SNF 出院，而不是 HSC（均 P<0.001）。与 HSC 相比，HHA 和 SNF 患者在 30 天内再次入院的可能性分别增加了 34%和 67%。HHA 和 SNF 环境也与 90 天内再次入院的风险增加 33%和 69%相关。出院去向与再入院原因之间无关联。
在肝胰手术患者中，HHA 和 SNF 患者在 30 天和 90 天内再入院的风险更高。再入院原因和出院设置没有差异。由于医疗保健系统试图降低手术后的再入院率，因此应进一步评估出院设置与再入院风险增加之间的关系。
