Department of Surgery, University of Michigan, 2124 Taubman Center, 1500 E. Medical Center Dr., SPC 5343, Ann Arbor, MI, 48109, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
J Gastrointest Surg. 2020 Nov;24(11):2602-2612. doi: 10.1007/s11605-019-04407-6. Epub 2019 Nov 21.
Ileostomy surgery is associated with a high readmission rate, and care pathways to prevent readmissions have been proposed. However, the extent to which readmission rates have improved is unknown. This study examined rates of readmission and emergency department visits ("return to hospital," or RTH) across hospitals in Michigan.
This was a retrospective cohort study of patients undergoing colorectal surgery with ileostomy formation from July 2012 to August 2017 in twenty Michigan Surgical Quality Collaborative (MSQC) hospitals. Primary outcome was RTH within 30 days of surgery. Multivariable logistic regression was used to identify risk factors for RTH. RTH rates over time were calculated, and hospitals' risk-adjusted rates were estimated using a multivariable model. Hospitals were divided into quartiles by risk-adjusted RTH rates, and RTH rates were compared between quartiles.
Of 982 patients, 28.5% experienced RTH. Rates of RTH did not decrease over time. Adjusted hospital RTH rates ranged from 9.4 to 43.3%. The risk-adjusted rate in the best-performing hospital quartile was 17.5% vs. 37.3% in the worst-performing quartile (p < 0.001). Hospitals that were outliers for ileostomy RTH were not outliers for colorectal resection RTH in general.
Rates of RTH following ileostomy surgery are high and vary between hospitals. This suggests inconsistent or ineffective use of pathways to prevent these events and potential for improvement. There is clear opportunity to standardize care to prevent RTH after ileostomy surgery.
回肠造口术与高再入院率相关，已提出预防再入院的护理途径。然而，再入院率改善的程度尚不清楚。本研究调查了密歇根州 20 家密歇根外科质量协作（MSQC）医院中进行结肠直肠手术和回肠造口术的患者的再入院率和急诊就诊率（“返回医院”或 RTH）。
这是一项回顾性队列研究，纳入 2012 年 7 月至 2017 年 8 月期间在 20 家密歇根外科质量协作（MSQC）医院接受结肠直肠手术并形成回肠造口术的患者。主要结局为手术后 30 天内 RTH。采用多变量逻辑回归分析 RTH 的危险因素。计算了随时间推移的 RTH 发生率，并使用多变量模型估计了医院的风险调整 RTH 率。根据风险调整后的 RTH 率将医院分为四分位数，并比较四分位数之间的 RTH 率。
在 982 名患者中，28.5%发生 RTH。RTH 率并未随时间降低。调整后的医院 RTH 率范围为 9.4%至 43.3%。表现最好的四分位数医院的风险调整 RTH 率为 17.5%，而表现最差的四分位数医院为 37.3%（p<0.001）。回肠造口术 RTH 异常的医院在一般情况下也不是结直肠切除术 RTH 的异常医院。
回肠造口术后 RTH 的发生率较高，且在医院之间存在差异。这表明预防这些事件的护理途径不一致或无效，并有改善的空间。有明确的机会使回肠造口术后 RTH 的护理标准化。
