Division of Gastroenterology, University of California, San Diego, La Jolla, California.
Division of Hospital Medicine, University of California, San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, California.
Clin Gastroenterol Hepatol. 2020 Aug;18(9):1939-1948.e7. doi: 10.1016/j.cgh.2019.08.042. Epub 2019 Aug 27.
BACKGROUND & AIMS: We investigated 30- and 90-day rates and causes of, risk factors for, and interventions to reduce hospital readmission in patients who received medical treatment for inflammatory bowel diseases (IBD).
We performed a systematic search of publications through July 1, 2018 for studies of rates of hospital readmission and associated causes and risk factors in patients who received medical treatments for IBD. Our final analysis included 17 cohort studies (6324 patients) of hospitalized adults with IBD who had received medical treatment, along with reported readmission rates with detailed chart review. We performed random effects meta-analysis to estimate 30- and 90-day rates of readmission and identified causes and risk factors associated with readmission. We also performed qualitative analyses of studies that focused on interventions to reduce readmission.
Overall, the 30-day rate of readmission was 18.1% (95% CI, 14.4-22.4) and the 90-day rate was 26.0% (95% CI, 22.7-29.6). On meta-regression, studies with higher proportions of patients with ulcerative colitis than Crohn's disease reported higher risks for readmission. Most common reasons for readmission were IBD flare, infection, or complications from unplanned surgeries during hospitalizations. Consistent risk factors for 30-day readmission were admission for pain control (odds ratio [OR], 2.27; 95% CI, 1.69-3.03), need for total parenteral nutrition on discharge (OR, 2.13; 95% CI, 1.36-3.35), and prior or unplanned surgery during admission (OR, 3.11; 95% CI, 2.27-4.25). Only 1 study focused on interventions (specialized inpatient IBD service) to reduce risk of readmission.
Overall 30- and 90-day rates of readmission for patients who received medical treatment for IBD are 18.1% and 26.0%, respectively. IBD flares and infections are common reasons for readmission, and inadequate pain control and need for parenteral nutrition were common risk factors. Interventional studies to reduce risk of readmission are needed.
我们调查了接受炎症性肠病（IBD）治疗的患者 30 天和 90 天的再入院率以及再入院的原因、危险因素和减少再入院的干预措施。
我们对截至 2018 年 7 月 1 日发表的有关 IBD 患者接受医疗治疗后的再入院率及相关病因和危险因素的研究进行了系统的文献检索。我们的最终分析包括 17 项队列研究（6324 例住院成人 IBD 患者），这些患者接受了医疗治疗，并对详细的图表审查报告了再入院率。我们进行了随机效应荟萃分析，以估算 30 天和 90 天的再入院率，并确定了与再入院相关的病因和危险因素。我们还对专注于减少再入院干预措施的研究进行了定性分析。
总体而言，30 天的再入院率为 18.1%（95%CI，14.4-22.4），90 天的再入院率为 26.0%（95%CI，22.7-29.6）。在元回归中，溃疡性结肠炎患者比例较高的研究报告的再入院风险更高。再入院的最常见原因是 IBD 发作、感染或住院期间计划外手术的并发症。30 天再入院的一致危险因素包括因疼痛控制入院（优势比[OR]，2.27；95%CI，1.69-3.03）、出院时需要全肠外营养（OR，2.13；95%CI，1.36-3.35）以及住院期间的既往或计划外手术（OR，3.11；95%CI，2.27-4.25）。仅有 1 项研究关注于减少再入院风险的干预措施（专门的住院 IBD 服务）。
接受 IBD 治疗的患者的总体 30 天和 90 天再入院率分别为 18.1%和 26.0%。IBD 发作和感染是再入院的常见原因，而疼痛控制不足和需要肠外营养是常见的危险因素。需要进行干预性研究以降低再入院的风险。
