Division of Colon and Rectal Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
Dis Colon Rectum. 2019 Apr;62(4):476-482. doi: 10.1097/DCR.0000000000001272.
Hospital readmissions after elective colectomy are costly and potentially preventable. It is unknown whether hospital discharge on a weekend impacts readmission risk.
This study aimed to use a national database to determine whether discharge on a weekend versus weekday impacts the risk of readmission, and to determine what discharge-related factors impact this risk.
This investigation is a retrospective cohort study.
Data were derived from the University HealthSystem Consortium, PATIENTS:: Adults who underwent elective colectomy from 2011 to 2015 were included.
The primary outcome measured was the 30-day hospital readmission rate.
Of the 76,031 patients who survived the index hospitalization, the mean age of the study population was 58 years; half were men and more than 75% were white. Overall, 20,829 (27%) were discharged on the weekend, and the remaining 55,202 (73%) were discharged on weekdays. The overall 30-day readmission rate was 10.5%; 8.9% for those discharged on the weekend vs 11.1% for those discharged during the weekday (unadjusted OR, 0.78; 95% CI, 0.74-0.83). The adjusted readmission risk was lower for patients discharged home without services (routine, without organized home health service) on a weekend compared with on a weekday (adjusted OR, 0.87; 95% CI, 0.81-0.93; readmission rates, 7.4% vs 8.9%, p < 0.001); however, the combination of weekend discharge and the need for home services increased readmission risk (adjusted OR, 1.39; 95% CI, 1.25-1.55; readmission rate, 16.2% vs 8.9%, p < 0.001). Although patients discharged to rehabilitation and skilled nursing facilities were at an increased risk of readmission compared with those discharged to home, there was no additive increase in risk of readmission for weekend discharge.
Data did not capture readmission beyond 30 days or to nonindex hospitals.
Patients discharged on a weekend following elective colectomy were at increased risk of readmission compared with patients discharged on a weekday if they required organized home health services. Further prospective studies are needed to identify areas of intervention to improve the discharge infrastructure. See Video Abstract at http://links.lww.com/DCR/A799.
择期结肠切除术（elective colectomy）后住院再次入院费用高昂且可能可以预防。目前尚不清楚周末出院是否会影响再入院风险。
本研究旨在使用国家数据库确定周末出院与平日出院是否会影响再入院风险，并确定哪些出院相关因素会影响这种风险。
本研究是一项回顾性队列研究。
数据来自于大学健康系统联盟（University HealthSystem Consortium）。
纳入 2011 年至 2015 年间接受择期结肠切除术的成年人。
主要观察指标是 30 天的医院再入院率。
在 76031 名存活至指数住院期的患者中，研究人群的平均年龄为 58 岁；一半为男性，超过 75%为白人。总体而言，20829 名（27%）患者在周末出院，其余 55202 名（73%）患者在平日出院。总的 30 天再入院率为 10.5%；周末出院患者为 8.9%，平日出院患者为 11.1%（未调整比值比，0.78；95%置信区间，0.74-0.83）。与平日出院相比，周末出院且无需服务（常规出院，无组织化家庭健康服务）的患者再入院风险较低（调整比值比，0.87；95%置信区间，0.81-0.93；再入院率，7.4% vs 8.9%，p < 0.001）；然而，周末出院和家庭服务需求的组合增加了再入院风险（调整比值比，1.39；95%置信区间，1.25-1.55；再入院率，16.2% vs 8.9%，p < 0.001）。与出院至家庭的患者相比，出院至康复和熟练护理设施的患者再入院风险增加，但周末出院并未增加再入院风险。
数据未捕获 30 天以上或非指数医院的再入院情况。
与平日出院相比，择期结肠切除术患者如果需要组织化家庭健康服务，周末出院的再入院风险增加。需要进一步的前瞻性研究来确定改善出院基础设施的干预领域。观看视频摘要请访问 http://links.lww.com/DCR/A799。
