Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
Department of Cardiac Surgery Research, Inova Heart and Vascular Institute, Falls Church, Virginia.
Ann Thorac Surg. 2020 Jun;109(6):1797-1803. doi: 10.1016/j.athoracsur.2019.09.048. Epub 2019 Nov 7.
Readmissions cost an estimated $41 billion in the United States each year. To address this, a single institution recently developed a new risk model predictive of 30-day readmission after adult cardiac surgery. The purpose of this study is to validate and refine this new readmission risk model using a statewide database.
A total of 19,964 patients were analyzed using a statewide Society of Thoracic Surgeons database (2014-2017). The aforementioned multivariate model was replicated (model 1): race, hospital length of stay, chronic lung disease, operation type, and renal failure. Model 2 also included discharge location. Thirty-day readmission risk scores and low-risk (0%-10%), moderate-risk (10%-13%), and high-risk (≥13%) categories were calculated.
The overall 30-day readmission rate was 11.1% with both models 1 and 2 predicting readmission (odds ratio, 1.09; 95% confidence interval, 1.08-1.11 vs odds ratio, 1.10; 95% confidence interval, 1.08-1.11). Statistically significant differences were observed across all risk categories in discharge location and total cost. For models 1 and 2, 86% of low-risk patients were discharged to home vs 66.9% and 42.9% of patients in high-risk groups, respectively (P < .001). The largest increases were observed with a hospice discharge location for both model 1 (from $37,930 to $89,285) and model 2 (from $37,930 to $89,230).
Both risk models significantly predicted 30-day readmission in our multiinstitutional dataset, confirming the score is valid and a generalizable quality improvement tool. The addition of discharge location and total cost adds valuable information of the ongoing efforts to identify patients at high risk for readmission.
据估计，美国每年的再入院费用约为 410 亿美元。为了解决这个问题，一家机构最近开发了一种新的风险模型，可以预测成人心脏手术后 30 天内的再入院率。本研究的目的是使用全州范围的数据库验证和改进这种新的再入院风险模型。
使用全州范围的胸外科医生协会数据库（2014-2017 年）对 19964 例患者进行了分析。复制了上述多变量模型（模型 1）：种族、住院时间、慢性肺部疾病、手术类型和肾衰竭。模型 2 还包括出院地点。计算了 30 天再入院风险评分和低风险（0%-10%）、中风险（10%-13%）和高风险（≥13%）类别。
两个模型（1 和 2）均预测再入院，总再入院率为 11.1%（优势比，1.09；95%置信区间，1.08-1.11 与优势比，1.10；95%置信区间，1.08-1.11）。在出院地点和总费用方面，所有风险类别均存在统计学显著差异。对于模型 1 和 2，86%的低风险患者出院回家，而高风险组分别有 66.9%和 42.9%的患者出院（P<.001）。对于模型 1（从 37930 美元增加到 89285 美元）和模型 2（从 37930 美元增加到 89230 美元），观察到最大的增加是与临终关怀出院地点相关。
这两个风险模型在我们的多机构数据集都显著预测了 30 天再入院，证实了该评分是有效的，是一种可推广的质量改进工具。添加出院地点和总费用为识别再入院高风险患者的持续努力提供了有价值的信息。
