From the Department of Vascular Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ont. (Papadopoulos, Devries, Montbriand, Eisenberg, De Mestral, Roche-Nagle); and the Department of Obstetrical Anesthesia, Sunnybrook Research Institute, Toronto, Ont. (Montbriand).
Can J Surg. 2019 Dec 1;62(6):412-417. doi: 10.1503/cjs.010318.
Patients who undergo vascular surgery are burdened by high early readmission rates. We examined the frequency and cause of early readmissions after elective and emergent admission to the vascular surgery service at our institution to identify modifiable targets for quality improvement.
Over a 5-year period, all patients admitted and readmitted to the vascular surgery service were identified. Medical records were then individually reviewed to identify baseline characteristics from the index admission and the most responsible diagnosis for readmission within 28 days of discharge.
Of a total of 3324 patients, 421 (12.7%) were readmitted to our institution within 28 days of discharge. Forty-seven were found to have more than 1 readmission following their index admission. The readmission rate ranged from 11.8% to 14.1% over the 5-year study period, resulting in an average readmission rate of 12.7%. There were similar rates for men (12.9%) and women (12.3%). Of the readmitted cases, 236 (63.1%) were unplanned readmissions. The most common diagnoses for unplanned readmissions were worsening of peripheral arterial disease status including complications related to peripheral bypass graft (30.9%), surgical site infections (15.3%) and nonsurgical infections (14.8%).
To reduce readmission rates effectively, institutions must identify highrisk patients. In our study cohort, the most frequent pathology resulting in readmission was peripheral arterial disease. The most frequent preventable reason for readmission was surgical site infection. Interventions focused on early assessment of clinical status and wounds in addition to avoidance of infectious complications could help reduce readmission rates. Preventive resources can be efficiently targeted by focusing on subgroups at risk for readmission.
接受血管外科手术的患者面临着较高的早期再入院率。我们检查了在我们机构的血管外科服务处择期和紧急入院后早期再入院的频率和原因，以确定质量改进的可修改目标。
在 5 年期间，确定了所有入院和再入院到血管外科服务处的患者。然后逐个审查病历，以确定索引入院时的基线特征和出院后 28 天内再入院的最主要诊断。
在总共 3324 名患者中，有 421 名（12.7％）在出院后 28 天内被重新入院到我们的机构。有 47 人在其索引入院后被发现有不止一次的再入院。在 5 年的研究期间，再入院率从 11.8％到 14.1％不等，导致平均再入院率为 12.7％。男性（12.9％）和女性（12.3％）的再入院率相似。在再入院的病例中，有 236 例（63.1％）为非计划性再入院。非计划性再入院的最常见诊断是外周动脉疾病状况恶化，包括与外周旁路移植术相关的并发症（30.9％）、手术部位感染（15.3％）和非手术感染（14.8％）。
为了有效地降低再入院率，机构必须确定高风险患者。在我们的研究队列中，导致再入院的最常见病理是外周动脉疾病。最常见的可预防再入院原因是手术部位感染。专注于早期评估临床状况和伤口以及避免感染并发症的干预措施可能有助于降低再入院率。通过关注有再入院风险的亚组，可以有效地针对预防资源。
