Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland.
Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN.
Surgery. 2019 Dec;166(6):1068-1075. doi: 10.1016/j.surg.2019.08.006. Epub 2019 Sep 20.
This study aimed to determine timing and risk factors for 30- and 90-day unplanned hospital readmissions and return to the operating room.
Retrospective case series, including consecutive adult patients with Crohn's disease, undergoing a major abdominal surgical procedure during a 3.5-year inclusion period was performed. The primary outcomes were 0- to 30-day and 30- to 90-day readmission and return to the operating room rates. Univariate and multivariable risk factors for both outcomes at 30 and 90 days were assessed through Cox regression analysis.
Of 680 included patients with Crohn's disease, 89 (13.1%) were readmitted within 30 days, 55 (8.1%) within 30-90 days, and 11 (1.6%) in both follow-up periods for a combined 90-day readmission rate of 24.4% (n = 166). Multivariable risk factors for 30-day readmissions were type of procedure performed, corticosteroid use (hazard ratio [HR] 1.71, P = .01), younger age (HR 0.98 per year, P = .01), and prolonged disease duration (HR 1.03 per year, P = .03). No significant risk factors identified for 30- to 90-day readmissions. By 90 days, 76 patients (11.2%) had a return to the operating room (of which 8.8% was within 30 days). Risk factors for 30-day return to the operating room included tobacco use (HR 1.86, P = .04), diabetes (HR 3.30, P = .01), corticosteroid use (HR 3.51, P <.001), and preoperative immunomodulator therapy (HR 2.70, P < .001).
Type of surgery, corticosteroid use, younger age, and prolonged disease duration were associated with 30-day hospital readmission, and tobacco use, diabetes, corticosteroid use, and preoperative immunomodulator therapy were risk factors for 30-day return to the operating room. Postoperative biologic therapy did not increase hospital readmission or return to operating room rates within 90 days of surgery.
本研究旨在确定 30 天和 90 天非计划性住院再入院和返回手术室的时间和风险因素。
回顾性病例系列研究，纳入了在 3.5 年纳入期间接受主要腹部手术的连续成年克罗恩病患者。主要结局为 0 至 30 天和 30 至 90 天的再入院率和返回手术室率。通过 Cox 回归分析评估了 30 天和 90 天这两个结果的单变量和多变量风险因素。
在 680 例克罗恩病患者中，89 例（13.1%）在 30 天内再次入院，55 例（8.1%）在 30-90 天内再次入院，11 例（1.6%）在两个随访期内再次入院，90 天内再入院率为 24.4%（n=166）。30 天再入院的多变量危险因素包括手术类型、使用皮质类固醇（风险比 [HR] 1.71，P=0.01）、年龄较小（HR 每年 0.98，P=0.01）和疾病持续时间延长（HR 每年 1.03，P=0.03）。未确定 30 至 90 天再入院的显著危险因素。90 天时，76 例（11.2%）患者返回手术室（其中 8.8%在 30 天内）。30 天内返回手术室的危险因素包括吸烟（HR 1.86，P=0.04）、糖尿病（HR 3.30，P=0.01）、使用皮质类固醇（HR 3.51，P<.001）和术前免疫调节剂治疗（HR 2.70，P<.001）。
手术类型、皮质类固醇使用、年龄较小和疾病持续时间延长与 30 天内住院再入院相关，吸烟、糖尿病、皮质类固醇使用和术前免疫调节剂治疗是 30 天内返回手术室的危险因素。术后生物治疗并未增加术后 90 天内的住院再入院率或返回手术室率。
