Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
The Duke Clinical Research Institute, Durham, North Carolina.
Am J Cardiol. 2019 Jan 1;123(1):33-43. doi: 10.1016/j.amjcard.2018.09.028. Epub 2018 Sep 27.
The cost of inpatient percutaneous coronary interventions (PCI) procedure is related to length of stay (LOS). It is unknown, how LOS may be associated with readmission rates and costs of index PCI and readmissions in elective PCI. This study aims to evaluate rates, predictors, causes, and costs associated with 30-day unplanned readmissions according to lLOS in patients, who underwent elective PCI. We included patients in the Nationwide Readmission Database, who were admitted to hospital from 2010 to 2014, who underwent uncomplicated elective PCI. LOS was defined as 0, 1, 2, and ≥3 days. A total of 324,345 patients were included in the analysis and the 30-day unplanned readmission was 4.75%, 4.67%, 6.44%, and 9.42% in the LOS groups 0, 1, 2, and ≥3 days, respectively. Prolonged LOS was associated with increased average total 30-day cost (index and readmission cost, 0 days $15,063, 1 day $14,693, 2 days $18,136, and ≥3 days $24,336). Compared with 0 days, the odds of readmissions were greater for 2 days (odds ratio 1.41, 95% confidence interval 1.07 to 1.87, p = 0.016) and ≥3 days (odds ratio 1.70, 95% confidence interval 1.28 to 2.24, p <0.001). Comorbidities were strong predictors of LOS and noncardiac causes, account for more than half of all causes for readmission. Longer LOS was associated with reduced incidence of readmissions for noncardiac causes such as noncardiac chest pain, but a greater rate of readmissions for heart failure. In conclusion, shorter length of stay was associated with reduced healthcare costs in elective PCI.
住院经皮冠状动脉介入治疗（PCI）的费用与住院时间（LOS）有关。目前尚不清楚 LOS 与择期 PCI 患者的再入院率和指数 PCI 及再入院的费用之间有何关联。本研究旨在评估根据接受择期 PCI 的患者 LOS 情况，评估 30 天内计划外再入院的发生率、预测因素、原因和费用。我们纳入了 2010 年至 2014 年期间因非复杂性择期 PCI 住院的患者，将其纳入全国再入院数据库。LOS 定义为 0、1、2 和≥3 天。共有 324345 例患者纳入分析，LOS 组 0、1、2 和≥3 天的 30 天内未计划再入院率分别为 4.75%、4.67%、6.44%和 9.42%。较长的 LOS 与平均 30 天总费用（指数和再入院费用）的增加相关（0 天为 15063 美元，1 天为 14693 美元，2 天为 18136 美元，≥3 天为 24336 美元）。与 0 天相比，2 天（优势比 1.41，95%置信区间 1.07 至 1.87，p=0.016）和≥3 天（优势比 1.70，95%置信区间 1.28 至 2.24，p<0.001）的再入院几率更大。合并症是 LOS 和非心脏原因的重要预测因素，占所有再入院原因的一半以上。较长的 LOS 与非心脏原因（如非心脏性胸痛）的再入院发生率降低相关，但心力衰竭的再入院率更高。总之，较短的住院时间与择期 PCI 的医疗保健费用降低有关。
