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慢性肠系膜缺血血管内或手术再血管化治疗后 30 天内再入院:来自全国再入院数据库的见解。

Thirty-day readmission after endovascular or surgical revascularization for chronic mesenteric ischemia: Insights from the Nationwide Readmissions Database.

机构信息

1 Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI, USA.

2 Mid America Heart and Vascular Institute, St Luke's Hospital, Kansas City, MO, USA.

出版信息

Vasc Med. 2019 Jun;24(3):216-223. doi: 10.1177/1358863X18816816. Epub 2019 Feb 10.

Abstract

There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.

摘要

目前关于慢性肠系膜缺血(CMI)血运重建后再入院的数据有限。本研究旨在确定血管内或手术血运重建后 30 天内 CMI 再入院的发生率、原因、预测因素和费用。从全国再入院数据库中确定了 2013 年至 2014 年期间血管内或手术血运重建后出院的 CMI 患者。使用加权全国估计值确定 30 天全因、非择期再入院的发生率、原因、住院时间和费用。使用分层逻辑回归确定 30 天再入院的独立预测因素。在 4671 例接受肠系膜血运重建的 CMI 患者中,19.5%的患者在出院后 30 天内再次入院,中位时间为 10 天。超过 25%的再入院是心血管或脑血管疾病,其中大多数是外周或内脏动脉粥样硬化和充血性心力衰竭。30 天再入院的独立预测因素包括非择期指数入院、慢性肾脏病(CKD)和出院至家庭保健或熟练护理设施。血运重建方式并不能独立预测再入院。在一项对接受血运重建的 CMI 患者进行的全国性回顾性分析中,约五分之一的患者在 30 天内再次入院。预测因素主要是不可改变的,包括非择期指数入院、CKD 和出院处置。

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