Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
J Surg Res. 2021 Apr;260:359-368. doi: 10.1016/j.jss.2020.11.035. Epub 2020 Dec 30.
The Emergency General Surgery (EGS) population is particularly at high risk for readmission. Currently, no system exists to predict which EGS patients are most at risk. We hypothesized that a subset of EGS patients could be identified with increased 30-day unplanned readmission. We also hypothesized that a majority of readmissions occur sooner than the conventional 2-week follow-up period.
National Surgical Quality Improvement Program (NSQIP) nonelective general surgery patients were analyzed. Multivariable logistic regression identified factors with increased odds of unplanned readmission. AAST EGS Diagnosis Categories were used to categorize postop ICD-9 codes, and the top 10 CPT codes in each group were analyzed. Readmission rate, the reason for unplanned readmission, and time to readmission were analyzed.
A total of 383,726 patients were identified with a readmission rate of 8.1% within 30 d of their primary procedure. The top 50 CPT codes accounted for 84% of EGS readmissions. Increased readmission risk was demonstrated for underweight patients (OR = 1.15, P < 0.05). High-risk hospital characteristics were LOS >2 d, any inpatient pulmonary complications, and discharge to any facility or rehab (all P < 0.05). Surgical site infections cause nearly 25% of readmissions. Intestinal procedures are most frequently readmitted (22% of EGS readmissions), with colorectal procedures having the higher odds of readmission. Most readmissions occur <10 d after discharge.
A high-risk subpopulation exists within EGS, and most readmissions occur sooner than a typical 2-week follow-up. Early interventions for high-risk EGS subpopulations may allow for early intervention and reduction of unnecessary healthcare utilization.
急诊普通外科 (EGS) 患者尤其有再次入院的高风险。目前，尚无系统可以预测哪些 EGS 患者风险最高。我们假设可以确定一组 EGS 患者存在较高的 30 天非计划性再入院风险。我们还假设大多数再入院发生在传统的 2 周随访期之前。
对国家外科质量改进计划 (NSQIP) 非选择性普通外科患者进行分析。多变量逻辑回归确定了增加非计划性再入院几率的因素。使用 AAST EGS 诊断类别对术后 ICD-9 编码进行分类，并对每组中的前 10 个 CPT 代码进行分析。分析了再入院率、非计划性再入院的原因和再入院时间。
共确定 383726 例患者，其主要手术 30 天内再入院率为 8.1%。前 50 个 CPT 代码占 EGS 再入院的 84%。体重不足患者的再入院风险增加（OR=1.15，P<0.05）。高危医院特征包括 LOS>2 天、任何住院肺部并发症和出院至任何医疗机构或康复机构（均 P<0.05）。手术部位感染导致近 25%的再入院。肠道手术是最常再入院的手术（EGS 再入院的 22%），结直肠手术的再入院几率更高。大多数再入院发生在出院后<10 天内。
EGS 中有一个高风险亚群，大多数再入院发生在典型的 2 周随访之前。对 EGS 高危亚群进行早期干预可能有助于早期干预和减少不必要的医疗保健利用。
