Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana, USA.
Am J Gastroenterol. 2019 Mar;114(3):464-471. doi: 10.14309/ajg.0000000000000050.
There is a lack of data on the impact of readmission to the same vs a different hospital following an index hospital discharge in cirrhosis patients.
We sought to describe rates and predictors of different-hospital readmissions (DHRs) among patients with cirrhosis and also determine the impact on cirrhosis outcomes including all-cause inpatient mortality and hospital costs. Using the national readmissions database, we identified cirrhosis hospitalizations in 2013. Regression analysis was used to determine the predictors of DHRs. A time-to-event analysis was performed to assess the impact on subsequent readmissions and all-cause inpatient mortality.
In 2013, there were 109,039 cirrhosis readmissions with 67% of these being same-hospital readmissions and 33% being DHRs (P < 0.001). Two percent of readmitted patients were treated at ≥4 different hospitals. The 30-day readmission rate was 29.1%. Predictors of DHR included Medicaid payer (adjusted odds ratio [OR] 1.07, 95% confidence interval [95% CI] 1.01-1.14), age (OR 0.98, 95% CI 0.978-0.982), elective admission (OR 1.09, 95% CI 1.01-1.17), hepatic encephalopathy (OR 1.20, 95% CI 1.16-1.25), hepatorenal syndrome (OR 1.09, 95% CI 1.03-1.16), and low socioeconomic status (OR 1.15, 95% CI 1.06-1.25). No difference was observed in 30-day readmission risk following a DHR (adjusted hazard ratio 1.044, 95% CI 0.975-1.118). In addition, there was no increased risk of inpatient death observed during a DHR within 30 days (adjusted hazard ratio 1.08, 95% CI 0.94-1.23). However, patients with DHR had significantly higher hospital costs and length of stay.
Majority of cirrhosis readmissions are same-hospital readmissions. Different-hospital readmissions do not increase the risk of 30-day readmissions and inpatient mortality but are associated with higher hospital costs.
在肝硬化患者出院后再次入住同一医院或不同医院的再入院率方面，数据相对缺乏。
我们旨在描述肝硬化患者中不同医院再入院（DHR）的发生率和预测因素，并确定其对肝硬化结局的影响，包括全因住院死亡率和住院费用。我们使用国家再入院数据库，确定了 2013 年的肝硬化住院患者。回归分析用于确定 DHR 的预测因素。进行生存分析以评估对随后再入院和全因住院死亡率的影响。
2013 年，有 109039 例肝硬化再入院，其中 67%为同一医院再入院，33%为 DHR（P<0.001）。有 2%的再入院患者在≥4 家不同医院接受治疗。30 天再入院率为 29.1%。DHR 的预测因素包括医疗补助支付人（调整后的优势比[OR] 1.07，95%置信区间[95%CI]1.01-1.14）、年龄（OR 0.98，95%CI 0.978-0.982）、择期入院（OR 1.09，95%CI 1.01-1.17）、肝性脑病（OR 1.20，95%CI 1.16-1.25）、肝肾综合征（OR 1.09，95%CI 1.03-1.16）和低社会经济地位（OR 1.15，95%CI 1.06-1.25）。在 DHR 后 30 天内，再入院风险未见差异（调整后的危害比 1.044，95%CI 0.975-1.118）。此外，在 DHR 后 30 天内，住院死亡风险未见增加（调整后的危害比 1.08，95%CI 0.94-1.23）。然而，DHR 患者的住院费用和住院时间明显更长。
大多数肝硬化再入院为同一医院再入院。不同医院的再入院并不会增加 30 天再入院和住院死亡率的风险，但与更高的住院费用相关。
