Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, 11794, NY, USA.
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Surg Endosc. 2019 Aug;33(8):2508-2516. doi: 10.1007/s00464-018-6539-8. Epub 2018 Dec 10.
Early readmissions (30 days) have been used as a measure of health care quality. The purpose of our study was to evaluate patterns of readmission for a longer period (up to 2 years) following Hepatopancreatobiliary (HPB) surgery in the state of New York.
The State Planning and Research Cooperative System database was utilized to identify patients undergoing complex HPB procedures between 2010 and 2012. Patients were followed for 2 years following surgery to identify all-cause readmissions. Factors for readmissions included patient demographics, comorbidities, perioperative complications, surgery type, and academic status. Multivariable generalized linear mixed models were performed to evaluate risk factors for readmissions.
There were 6207 complex HPB procedures with 1272 (20.49%) unplanned 30-day readmissions, 816 (13.15%) unplanned 31-90-day readmissions, 1678 (27.03%) unplanned 91-day to 1-year readmissions, and 1404 (22.62%) 1-2-year readmissions. After adjusting for other possible confounding factors, risk factors for 30-day readmissions include surgery type, as pancreatectomy and gallbladder patients are more likely to have a 30-day readmission than hepatectomy patients, facility type, as academic centers are more likely to have a readmission, male gender, presence of any comorbidity, and peri-operative complications. Risk factors for 31-90-day readmissions include race, insurance group, any comorbidity or any peri-operative complication, and 30-day readmissions. Risk factors for 91-day to 1-year readmissions include male gender, race, any comorbidity, 30-day readmissions, and 31-90 days' readmissions. Risk factors for 1-2-year readmissions include presence of any comorbidity, and previous 91-day to 1-year readmissions.
The 30-day readmission window is an inadequate, but predictive, measure of total readmission following complex HPB procedures.
早期再入院（30 天）已被用作衡量医疗质量的指标。我们的研究目的是评估在纽约州进行肝胰胆（HPB）手术后更长时间（长达 2 年）的再入院模式。
利用州规划和研究合作系统数据库，确定 2010 年至 2012 年间接受复杂 HPB 手术的患者。术后随访 2 年，以确定所有原因的再入院。再入院的因素包括患者人口统计学特征、合并症、围手术期并发症、手术类型和学术地位。采用多变量广义线性混合模型评估再入院的危险因素。
共有 6207 例复杂 HPB 手术，其中 1272 例（20.49%）为 30 天计划外再入院，816 例（13.15%）为 31-90 天计划外再入院，1678 例（27.03%）为 91-1 年计划外再入院，1404 例（22.62%）为 1-2 年计划外再入院。在调整其他可能的混杂因素后，30 天再入院的危险因素包括手术类型，如胰切除术和胆囊切除术患者比肝切除术患者更有可能在 30 天内再入院，以及手术机构类型，如学术中心更有可能发生再入院，男性，存在任何合并症和围手术期并发症。31-90 天再入院的危险因素包括种族、保险类型、任何合并症或任何围手术期并发症以及 30 天再入院。91-1 年再入院的危险因素包括男性、种族、任何合并症、30 天再入院和 31-90 天再入院。1-2 年再入院的危险因素包括存在任何合并症和之前的 91-1 年再入院。
30 天再入院窗口是评估复杂 HPB 手术后总再入院率的一个不充分但具有预测性的指标。
