Department of Surgery, University of Alabama at Birmingham, United States; Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, United States; Birmingham/Tuscaloosa VA Health Services Research & Development, United States.
Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, United States.
Am J Surg. 2018 Nov;216(5):912-918. doi: 10.1016/j.amjsurg.2018.05.004. Epub 2018 May 18.
We compared short-term recovery for patients discharged to inpatient rehabilitation versus skilled nursing facilities after gastrointestinal surgery.
MATERIALS & METHODS: We conducted a propensity-matched cohort study of 12,939 adults discharged to inpatient rehabilitation or skilled nursing facilities after colectomy, pancreatectomy or hepatectomy at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2014. Primary outcomes were readmission and mortality rates 30 days after surgery.
9259 (72%) patients were discharged to skilled nursing facilities and 3680 (28%) to inpatient rehabilitation. Median age in both groups was 76 years and 82% of patients were white. There was no difference in 30-day readmission rates (16% for skilled nursing vs 16.8% for inpatient rehabilitation) but post-discharge mortality was higher for patients discharged to skilled nursing facilities (4.4%) compared to inpatient rehabilitation (1.6%, p < 0.001).
Increased utilization of inpatient rehabilitation services after gastrointestinal surgery may improve postoperative outcomes.
我们比较了胃肠道手术后出院至住院康复病房与熟练护理机构的患者短期恢复情况。
我们对 2011 年至 2014 年期间参加美国外科医师学院国家外科质量改进计划的医院中接受结肠切除术、胰腺切除术或肝切除术的 12939 例成人进行了倾向评分匹配队列研究。主要结果是术后 30 天的再入院率和死亡率。
9259 例（72%）患者出院至熟练护理机构，3680 例（28%）出院至住院康复病房。两组患者的中位年龄均为 76 岁，82%的患者为白人。30 天再入院率无差异（熟练护理为 16%，住院康复为 16.8%），但出院至熟练护理机构的患者出院后死亡率较高（4.4%比住院康复为 1.6%，p<0.001）。
胃肠道手术后增加住院康复服务的利用率可能会改善术后结局。
