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退变性脊柱疾病腰椎手术后 30 天再入院的发生率、原因和危险因素。

Incidence, reasons, and risk factors for 30-day readmission after lumbar spine surgery for degenerative spinal disease.

机构信息

Department of Neurosurgery, Ajou University College of Medicine, Suwon, Republic of Korea.

Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.

出版信息

Sci Rep. 2020 Jul 29;10(1):12672. doi: 10.1038/s41598-020-69732-2.

Abstract

This study investigated risk factors for 30-day readmission of discharged patients who had undergone lumbar spinal surgery. This retrospective, case-control study reviewed 3,933 patients discharged after elective spinal surgery for lumbar degenerative diseases from 2005 to 2012 at a university hospital. Of these patients, 102 were re-hospitalized within 30 days of discharge. Patient medical records were reviewed. The incidence of readmission within 30 days was 2.6%, and uncontrolled pain was the most common reason for readmission. In the univariate analysis, age, mental illness, the number of medical comorbidities, previous spinal surgery, fusion surgery, number of fusion levels, estimated blood loss, operation time, intensive care unit (ICU) admission, length of hospital stays, and total medical expenses were associated with a higher risk of readmission within 30 days. Multiple logistic regression analysis revealed that previous spinal surgery, operation time, ICU admission, length of hospital stays, and total medical expenses were independent risk factors for 30-day readmission. Independent risk factors for readmission were longer operation time, a previous spinal surgery, ICU admission, longer hospital stays, and higher medical expenses. Further studies controlling these risk factors could contribute to reducing readmission and thus improving the quality of care.

摘要

本研究调查了接受腰椎脊柱手术出院患者 30 天再入院的风险因素。这是一项回顾性病例对照研究,对 2005 年至 2012 年期间在一家大学医院接受择期脊柱手术治疗腰椎退行性疾病的 3933 名患者进行了研究。其中 102 名患者在出院后 30 天内再次住院。回顾了患者的病历。30 天内再入院的发生率为 2.6%,未控制的疼痛是再入院的最常见原因。在单因素分析中,年龄、精神疾病、合并症数量、既往脊柱手术、融合手术、融合节段数量、估计失血量、手术时间、入住重症监护病房(ICU)、住院时间和总医疗费用与 30 天内再入院的风险增加相关。多因素逻辑回归分析显示,既往脊柱手术、手术时间、入住 ICU、住院时间和总医疗费用是 30 天再入院的独立危险因素。再入院的独立危险因素为手术时间较长、既往脊柱手术、入住 ICU、住院时间延长和医疗费用增加。进一步控制这些风险因素的研究可能有助于减少再入院,从而提高医疗质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5ce0/7391755/c14bd547e21d/41598_2020_69732_Fig1_HTML.jpg

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