Pooshpas Pardis, Lehman Erik, Aziz Faisal
Miscellaneous, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA.
Surgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2018 Nov 7;10(11):e3558. doi: 10.7759/cureus.3558.
Objectives Readmissions to hospital after surgical procedures are considered as reflective of poor quality of healthcare provided during the index hospitalization and are associated with increased costs of healthcare. Aortoiliac occlusive disease represents an aggressive form of atherosclerotic disease and has been traditionally treated with open surgical bypasses. Endovascular interventions for aortoiliac occlusive disease are associated with comparable outcomes to open surgical procedures. The purpose of this study is to review the factors associated with hospital readmission after aortoiliac endovascular interventions. Methods The 2015 procedure targeted American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and general and vascular surgery NSQIP participant user file (PUF) were used for this analysis. Patient, diagnosis and procedure characteristics of patients undergoing aortoiliac endovascular interventions were reviewed. Bivariate analysis was used to identify the relationship between the independent variables and 30-day readmission. The significant variables from the bivariate analysis were used to generate a multivariable logistic regression model. The predicted probability of readmission was calculated. Results Out of 823 patients, 86 were readmitted. Readmission was related to the principal procedure in 48 (73.9%) patients. A total of 61 (7%) patients underwent an unplanned operation within 30 days after the index procedure. A multivariable logistic regression model identified the following variables to be significantly associated with 30-day risk of readmission: the use of pre-procedural beta blocker (OR = 2.06, 95% CI = 1.23 - 3.45, P < 0.01), external/internal iliac intervention (OR = 1.95, 95% CI = 1.18 - 3.20, P <0.01), critical limb ischemia (OR = 1.80, 95% CI = 1.10 - 2.94, P <0.05), and unplanned return to the operating room (OR = 11.65, 95% CI = 6.35 - 21.35, P <0.01). The predicted probability of readmission was as follows: 5.5% for critical limb ischemia, 5.9% for external iliac artery angioplasty/stenting, 6.2% for preoperative beta blockers, 17.7% for patients with cardiac arrest, 27% for unplanned return to the operating room, and 94.7% for patients with all of these risk factors. Conclusion Readmissions after endovascular interventions for severe atherosclerotic disease can be used as a quality metric. Several factors place a patient at a high risk for readmission. Unplanned return to the operating room, cardiac arrest, preoperative beta blockers, location of disease, and preoperative symptoms are independent risk factors for hospital readmission. Unplanned return to the operating room is associated with 11.65-fold increase in the risk of hospital readmission.
手术后再次入院被视为首次住院期间所提供医疗保健质量不佳的反映，并且与医疗保健成本增加相关。主髂动脉闭塞性疾病是一种侵袭性动脉粥样硬化疾病，传统上采用开放性外科搭桥手术治疗。主髂动脉闭塞性疾病的血管内介入治疗与开放性外科手术具有相当的疗效。本研究的目的是回顾主髂动脉血管内介入治疗后与再次入院相关的因素。方法：使用2015年美国外科医师学会国家外科质量改进计划（NSQIP）数据库及普通外科和血管外科NSQIP参与者用户文件（PUF）进行本分析。回顾了接受主髂动脉血管内介入治疗患者的患者、诊断和手术特征。采用双变量分析来确定自变量与30天再入院之间的关系。双变量分析中的显著变量用于生成多变量逻辑回归模型。计算再入院的预测概率。结果：823例患者中，86例再次入院。48例（73.9%）患者的再次入院与主要手术相关。共有61例（7%）患者在首次手术后30天内接受了非计划手术。多变量逻辑回归模型确定以下变量与30天再入院风险显著相关：术前使用β受体阻滞剂（OR = 2.06，95%CI = 1.23 - 3.45，P < 0.01）、髂外/髂内介入（OR = 1.95，95%CI = 1.18 - 3.20，P < 0.01）、严重肢体缺血（OR = 1.80，95%CI = 1.10 - 2.94，P < 0.05）以及非计划返回手术室（OR = 11.65，95%CI = 6.35 - 21.35，P < 0.01）。再入院的预测概率如下：严重肢体缺血为5.5%，髂外动脉血管成形术/支架置入术为5.9%，术前使用β受体阻滞剂为6.2%，心脏骤停患者为17.7%，非计划返回手术室患者为27%，具有所有这些危险因素的患者为94.7%。结论：严重动脉粥样硬化疾病血管内介入治疗后的再入院可作为一种质量指标。几个因素使患者处于再入院的高风险中。非计划返回手术室、心脏骤停、术前使用β受体阻滞剂、疾病部位和术前症状是医院再入院的独立危险因素。非计划返回手术室与医院再入院风险增加11.65倍相关。
