Qayed Emad, Muftah Mayssan
Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30303, United States.
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, United States.
World J Gastrointest Endosc. 2018 Sep 16;10(9):200-209. doi: 10.4253/wjge.v10.i9.200.
To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.
We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We excluded patients who died during the hospitalization, and calculated 30 and 90-d unplanned readmission and care fragmentation rates. Readmission to a non-index hospital (., different from the hospital of the index admission) was considered as care fragmentation. A multivariate Cox regression model was used to analyze predictors of 30-d readmissions. Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation. Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission. Mortality during the first readmission, hospitalization cost, length of stay, and rates of 60-d readmission were compared between those with and without care fragmentation.
There were 30064 admissions with a primary diagnosis of gastroparesis. The rates of 30 and 90-d readmissions were 26.8% and 45.6%, respectively. Younger age, male patient, diabetes, parenteral nutrition, ≥ 4 Elixhauser comorbidities, longer hospital stay (> 5 d), large and metropolitan hospital, and Medicaid insurance were associated with increased hazards of 30-d readmissions. Gastric surgery, routine discharge and private insurance were associated with lower 30-d readmissions. The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%, respectively. Younger age, longer hospital stay (> 5 d), self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation. Diabetes, enteral tube placement, parenteral nutrition, large metropolitan hospital, and routine discharge were associated with decreased risk of 30-d fragmentation. Patients who were readmitted to a non-index hospital had longer length of stay (6.5 5.8 d, = 0.03), and higher mean hospitalization cost ($15645 $12311, < 0.0001), compared to those readmitted to the index hospital. There were no differences in mortality (1.0% 1.3%, = 0.84), and 60-d readmission rate (55.3% 54.6%, = 0.99) between the two groups.
Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis. Knowledge of these predictors can play a role in implementing effective preventive interventions to high-risk patients.
评估胃轻瘫住院患者的再入院率及医疗碎片化情况，并分析相关预测因素。
我们在2010 - 2014年全国再入院数据库中识别出所有以胃轻瘫为主要诊断的成人住院病例，该数据库涵盖了全州范围的再入院情况。我们排除了住院期间死亡的患者，并计算了30天和90天的非计划再入院率及医疗碎片化率。再次入住非索引医院（即与首次入院医院不同）被视为医疗碎片化。采用多变量Cox回归模型分析30天再入院的预测因素。使用逻辑回归确定与30天医疗碎片化独立相关的医院和患者因素。对30天内再入院的患者，从首次再入院出院后随访60天。比较了有和没有医疗碎片化的患者在首次再入院期间的死亡率、住院费用、住院时长以及60天再入院率。
共有30064例以胃轻瘫为主要诊断的入院病例。30天和90天的再入院率分别为26.8%和45.6%。年龄较小、男性患者、糖尿病、肠外营养、≥4种埃利克斯豪泽合并症、住院时间较长（>5天）、大型都市医院以及医疗补助保险与30天再入院风险增加相关。胃部手术、常规出院以及私人保险与30天再入院风险较低相关。30天和90天的医疗碎片化率分别为28.1%和33.8%。年龄较小、住院时间较长（>5天）、自费或医疗补助保险与30天医疗碎片化风险增加相关。糖尿病、放置肠内营养管、肠外营养、大型都市医院以及常规出院与30天医疗碎片化风险降低相关。与再次入住索引医院的患者相比，再次入住非索引医院的患者住院时间更长（6.5天对5.8天，P = 0.03），平均住院费用更高（15645美元对12311美元，P < 0.0001）。两组之间的死亡率（1.0%对1.3%，P = 0.84）和60天再入院率（55.3%对54.6%，P = 0.99）没有差异。
胃轻瘫患者30天再入院率高及医疗碎片化与多个因素相关。了解这些预测因素有助于对高危患者实施有效的预防干预措施。
