Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, 49 Jesse Hill Junior Drive, Atlanta, GA 30303, United States.
Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States.
Pancreatology. 2018 Jun;18(4):386-393. doi: 10.1016/j.pan.2018.04.006. Epub 2018 Apr 23.
Patients with chronic pancreatitis are prone to frequent readmissions. The aim of this study is to evaluate the rate and predictors of 30-day readmissions in patients with chronic pancreatitis using the Nationwide Readmission Database (NRD).
We performed a retrospective analysis of all adult patients with the principal discharge diagnosis of chronic pancreatitis from 2010 through 2014. We excluded patients who died during the hospitalization. Multivariate Cox proportional hazard regression was performed to identify demographic, clinical, and hospital factors that associated with 30-day unplanned readmissions.
During the study period, 25,259 patients had the principal discharge diagnosis of chronic pancreatitis and survived the index hospitalization. Of these, 6477 (26.7%) were readmitted within 30 days. Younger age group, males, length of stay >5 days, admission to a large, metropolitan hospital, and several comorbidities (renal failure, rheumatic disease, chronic anemia, heart failure, depression, drug abuse, psychosis, and diabetes) were independently associated with increased risk of 30-day readmission. ERCP, pancreatic surgery, and obesity were associated with lower risk. The most common reasons for readmissions were acute pancreatitis (30%), chronic pancreatitis (17%), pseudocyst (2%), and abdominal pain (6%).
One in four patients with chronic pancreatitis is readmitted within 30 days (26.7%). Pancreatic disease accounts for at least half of all readmissions. Several baseline comorbidities and characteristics are associated with 30-day readmission risk after index admission. Knowledge of these predictors can help design interventions to target high-risk patients and reduce readmissions and costs of care.
慢性胰腺炎患者容易频繁再次入院。本研究旨在使用全国再入院数据库（NRD）评估慢性胰腺炎患者 30 天再入院率及其预测因素。
我们对 2010 年至 2014 年期间所有患有慢性胰腺炎主要出院诊断的成年患者进行了回顾性分析。我们排除了在住院期间死亡的患者。采用多变量 Cox 比例风险回归分析确定与 30 天非计划再入院相关的人口统计学、临床和医院因素。
在研究期间，25259 例患者的主要出院诊断为慢性胰腺炎并在指数住院期间存活。其中，6477 例（26.7%）在 30 天内再次入院。年龄较小、男性、住院时间>5 天、入住大型、都市医院以及存在多种合并症（肾衰竭、风湿性疾病、慢性贫血、心力衰竭、抑郁、药物滥用、精神病和糖尿病）与 30 天再入院风险增加独立相关。ERCP、胰腺手术和肥胖与较低的再入院风险相关。再入院的最常见原因是急性胰腺炎（30%）、慢性胰腺炎（17%）、假性囊肿（2%）和腹痛（6%）。
每四个慢性胰腺炎患者中就有一个在 30 天内再次入院（26.7%）。至少一半的再入院是由胰腺疾病引起的。一些基线合并症和特征与指数入院后 30 天的再入院风险相关。了解这些预测因素可以帮助设计针对高危患者的干预措施，从而减少再入院和医疗费用。
