Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Surg Endosc. 2021 Aug;35(8):4667-4672. doi: 10.1007/s00464-020-07906-9. Epub 2020 Sep 1.
Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database.
The New York SPARCS database was used to identify all adult patients undergoing laparoscopic cholecystectomy for benign biliary disease between 2000 and 2016. Due to the presence of a unique identifier, patients with readmission to any New York hospital were evaluated. Planned versus unplanned readmission rates were compared. Following univariate analysis, multivariable logistic regression model was used to identify risk factors for unplanned readmissions after accounting for baseline characteristics, comorbidities and complications.
There were 591,627 patients who underwent LC during the studied time period. Overall 30-day readmission rate was 4.94% (n = 29,245) and unplanned 30-days readmission rate was 4.58% (n = 27,084). Female patients were less likely to have 30-day unplanned readmissions. Patients with age older than 65 or younger than 29 were more likely to have 30-day unplanned readmissions compared to patients with age 30-44 or 45-64. Insurance status was also significant, as patients with Medicaid/Medicare were more likely to have unplanned readmissions compared to commercial insurance. In addition, variables such as Black race, presence of any comorbidity, postoperative complication, and prolonged initial hospital length of stay were associated with subsequent readmission.
This data show that readmissions rates following LC are relatively low; however, majority of readmissions are unplanned. Most common reason for unplanned readmissions was associated with complications of the procedure or medical care. By identifying certain risk groups, unplanned readmissions may be prevented.
医院再入院是疾病相关成本的一个重要组成部分，会给医疗保健带来巨大负担。大多数评估腹腔镜胆囊切除术（LC）后再入院率的研究都是单中心研究，因此可能低估了实际再入院率。我们试图使用大型纵向数据库来检查 LC 后的再入院率和原因。
使用纽约 SPARCS 数据库确定 2000 年至 2016 年间因良性胆道疾病接受腹腔镜胆囊切除术的所有成年患者。由于存在唯一标识符，评估了有再入院至纽约任何医院的患者。比较计划性和非计划性再入院率。在单因素分析后，使用多变量逻辑回归模型，在考虑基线特征、合并症和并发症的情况下，确定非计划性再入院的危险因素。
在研究期间，有 591627 例患者接受了 LC。总体 30 天再入院率为 4.94%（n=29245），非计划性 30 天再入院率为 4.58%（n=27084）。女性患者 30 天非计划性再入院的可能性较小。年龄大于 65 岁或小于 29 岁的患者与 30-44 岁或 45-64 岁的患者相比，30 天非计划性再入院的可能性更高。保险状况也很重要，因为与商业保险相比，有医疗补助/医疗保险的患者更有可能出现非计划性再入院。此外，黑种人、存在任何合并症、术后并发症和初始住院时间延长等变量与随后的再入院有关。
这些数据表明，LC 后再入院率相对较低；然而，大多数再入院是计划外的。非计划性再入院的最常见原因与手术或医疗护理的并发症有关。通过确定某些风险群体，可以预防非计划性再入院。
