From the DeWitt Daughtry Family Department of Surgery, Miller School of Medicine (R.R., A.C.C., E.M.U., J.D.K., N.N., D.D.Y., E.G.), University of Miami; Jackson Memorial Hospital (M.S.C., D.L.J.), Miami; Department of Surgery, College of Medicine (G.J.C.), University of South Florida, Tampa; and Department of Surgery, College of Medicine (J.P.P.), Florida State University, Tallahassee, Florida.
J Trauma Acute Care Surg. 2021 Jan 1;90(1):64-72. doi: 10.1097/TA.0000000000002954.
Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would be different for same- and different-hospital readmissions.
The 2014 Nationwide Readmissions Database was queried for nonelective EGS hospitalizations. The outcomes were readmission to the index or different hospitals within 180 days with VTE. Multivariate logistic regressions identified risk factors for readmission to index and different hospitals with VTE, reported as odds ratios with their 95% confidence intervals. Patients were excluded if during the index admission they expired, developed a VTE, had a vena cava filter placed, or did not have at least 180 days of follow-up.
Of 1,584,605 patients meeting inclusion criteria, 1.3% (n = 20,963) of patients were readmitted within 180 days with a VTE. Of these, 28% (n = 5,866) were readmitted to a different hospital. Predictors overall for readmission with VTE were malignancy, prolonged hospitalization, age, and being publicly insured. However, predictors for readmission to a different hospital are based on hospital characteristics, including for-profit status, or procedure type.
Nearly one in three readmissions with VTE after EGS occurs at a different hospital and may be missed by current quality metrics that only capture same-hospital readmission. Such metrics may underestimate for-profit hospital postoperative VTE rates relative to public and nonprofit hospitals, potentially affecting benchmarking and reimbursement. Postdischarge VTE rate is associated with insurance status. These findings have implications for policy and prevention programming design.
Epidemiological study, level III.
先前关于急诊普通外科（EGS）后静脉血栓栓塞症（VTE）的研究在全国范围内不具有代表性，也不能完全捕捉到不同医院的再入院情况。我们假设，不同医院的再入院导致了 EGS 后 VTE 再入院的很大一部分，并且同一医院和不同医院的再入院的预测因素也会有所不同。
2014 年全国再入院数据库被查询了非选择性 EGS 住院患者。结果是在 180 天内因 VTE 再次入住索引或不同医院。多变量逻辑回归确定了 VTE 再入院至索引和不同医院的风险因素，报告为优势比及其 95%置信区间。如果在索引住院期间患者死亡、发生 VTE、放置腔静脉滤器或没有至少 180 天的随访，则排除患者。
在符合纳入标准的 1,584,605 名患者中，有 1.3%（n=20,963）的患者在 180 天内因 VTE 再次入院。其中，28%（n=5,866）患者被转至其他医院。VTE 再入院的总体预测因素包括恶性肿瘤、住院时间延长、年龄和公共保险。然而，不同医院再入院的预测因素基于医院特征，包括营利性和手术类型。
在 EGS 后 VTE 再入院中，近三分之一发生在不同的医院，而当前仅捕获同一医院再入院的质量指标可能会错过这些再入院。这种指标可能会低估营利性医院与公立医院和非营利性医院相比术后 VTE 率，从而影响基准测试和报销。出院后 VTE 率与保险状况有关。这些发现对政策和预防计划设计具有影响。
流行病学研究，三级。
