Hyde Laura Z, Al-Mazrou Ahmed M, Kuritzkes Ben A, Suradkar Kunal, Valizadeh Neda, Kiran Ravi P
Division of Colorectal Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
Department of Surgery, University of California San Francisco-East Bay, Oakland, CA, USA.
Int J Colorectal Dis. 2018 Dec;33(12):1667-1674. doi: 10.1007/s00384-018-3150-3. Epub 2018 Aug 30.
This study aims to assess factors associated with preventable readmissions after colorectal resection.
All readmissions following colorectal resection from May 2013 to May 2016 at an academic medical center were reviewed. Readmissions that could be prevented were identified. Factors associated with preventable readmission were assessed using logistic regression.
Of 686 patients discharged during the study period, there were 75 patients (11%) with unplanned readmission. Twenty-nine readmissions (39%) were preventable-these readmissions were due to dehydration or acute kidney injury, pain, ostomy complications, and gastrointestinal bleeding. On regression analysis, the strongest preoperative risk factors associated with preventable readmission were urgent or emergent operation (OR 4.0, 95% CI 1.6-9.9), recent myocardial infarction (OR 2.9, 95% CI 1.0-9.0), total or subtotal colectomy (OR 2.8, 95% CI 1.1-7.3), and American Society of Anesthesiologist score ≥ 3 (OR 2.2, 95% CI 1.0-4.7). Intraoperative risk factors associated with preventable readmission included intraoperative stapler complication (OR 24.2, 95% CI 1.5-397). Postoperative risk factors associated with preventable readmission included postoperative arrhythmia (OR 5.6, 95% CI 2.0-16.1), and postoperative anemia (OR 2.6, 95% CI 1.2-5.7). On multivariable analysis while controlling for procedure type, urgent or emergent operation (OR 2.9, 95% CI 1.1-8.2), intraoperative stapler complication (OR 37.5, 95% CI 2.3-627.8), and postoperative arrhythmia (OR 4, 95% CI 1.3-12.8) remained statistically significant.
Approximately 40% of readmissions following colorectal surgery are potentially preventable. Since specific patients and factors that are associated with preventable readmission can be identified, resources should be targeted to factors associated with preventable readmissions.
本研究旨在评估结直肠切除术后与可预防再入院相关的因素。
回顾了2013年5月至2016年5月在一家学术医疗中心接受结直肠切除术后的所有再入院病例。确定了可预防的再入院病例。使用逻辑回归分析与可预防再入院相关的因素。
在研究期间出院的686例患者中，有75例（11%）出现非计划再入院。29例再入院（39%）是可预防的——这些再入院是由于脱水或急性肾损伤、疼痛、造口并发症和胃肠道出血。回归分析显示，与可预防再入院相关的最强术前危险因素是急诊或紧急手术（比值比4.0，95%可信区间1.6 - 9.9）、近期心肌梗死（比值比2.9，95%可信区间1.0 - 9.0）、全结肠或次全结肠切除术（比值比2.8，95%可信区间1.1 - 7.3）以及美国麻醉医师协会评分≥3（比值比2.2，95%可信区间1.0 - 4.7）。与可预防再入院相关的术中危险因素包括术中吻合器并发症（比值比24.2，95%可信区间1.5 - 397）。与可预防再入院相关的术后危险因素包括术后心律失常（比值比5.6，95%可信区间2.0 - 16.1）和术后贫血（比值比2.6，95%可信区间1.2 - 5.7）。在多变量分析中，在控制手术类型的情况下，急诊或紧急手术（比值比2.9，95%可信区间1.1 - 8.2）、术中吻合器并发症（比值比37.5，95%可信区间2.3 - 627.8）和术后心律失常（比值比4，95%可信区间1.3 - 12.8）仍具有统计学意义。
结直肠手术后约40%的再入院可能是可预防的。由于可以确定与可预防再入院相关的特定患者和因素，资源应针对与可预防再入院相关的因素。
