Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina; Catalyst Medical Consulting, Simpsonville, South Carolina.
Department of General Surgery, University of South Carolina Greenville Memorial Hospital, Greenville, South Carolina.
Gastroenterology. 2018 Jul;155(1):38-46.e1. doi: 10.1053/j.gastro.2018.03.033. Epub 2018 Mar 28.
BACKGROUND & AIMS: We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States.
We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis.
The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P < .01). A higher proportion of readmitted patients had morbidities requiring prolonged mechanical ventilation (1.5%) compared with index admissions (0.8%) (P < .01). A total of 133,368 hospital days was associated with readmission, and the total health care in-hospital economic burden was $30.3 million (in costs) and $108 million (in charges). Independent predictors of readmission were Medicaid insurance, higher Charlson comorbidity score, lower income, residence in a metropolitan area, hemorrhagic shock, and longer stays in the hospital. Older age, private or no insurance, upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission.
In a retrospective study of patients hospitalized for non-variceal upper gastrointestinal hemorrhage, 13% are readmitted to the hospital within 30 days of discharge. Readmission is associated with higher mortality, morbidity, and resource use. Most readmissions are not for recurrent gastrointestinal bleeding.
我们旨在确定美国非静脉曲张性上消化道出血患者在出院后 30 天内的再住院率及其对死亡率、发病率和医疗保健利用的影响。
我们使用美国医疗保健研究与质量局医疗保健成本和利用项目全国再入院数据库进行了一项回顾性研究，该数据库涵盖了 2014 年 22 个州的 2048 家医院的 1490 万例住院数据。我们收集了 203220 名因急性非静脉曲张性上消化道出血住院并出院的成年人的再住院数据。主要结局是出院后 30 天内全因再入院率。次要结局为再入院原因、再入院死亡率、发病率（休克和延长机械通气）和资源利用（住院时间和总住院费用及费用）。使用 Cox 回归分析确定再入院的独立危险因素。
30 天再入院率为 13%。只有 18%的再入院是由于非静脉曲张性上消化道出血复发。再入院患者的死亡率（4.7%）高于初次入院患者（1.9%）（P<.01）。与初次入院相比，再入院患者需要长时间机械通气的发病率更高（1.5%比 0.8%）（P<.01）。再入院共导致 133368 天的住院治疗，总住院医疗经济负担为 3030 万美元（成本）和 1.08 亿美元（费用）。再入院的独立预测因素是医疗补助保险、较高的 Charlson 合并症评分、较低的收入、居住在大都市地区、出血性休克和住院时间延长。年龄较大、私人保险或无保险、上消化道内镜检查和延长机械通气与较低的再入院几率相关。
在一项对因非静脉曲张性上消化道出血住院的患者的回顾性研究中，13%的患者在出院后 30 天内再次住院。再入院与更高的死亡率、发病率和资源利用相关。大多数再入院不是由于胃肠道出血复发。
