Vallini Valerio, Venturini Luigi, Andreini Roberto, Sibilia Gabriella, Rinaldi Elisabetta, Bassu Raffaella, Mura Maddalena, Meini Simone
Azienda USL Toscana Nord Ovest, U.O. Medicina Interna, Felice Lotti Hospital, Pontedera, Pisa, Toscana, Italy.
Azienda Ospedaliero-Universitaria Pisana, U.O. Medicina Interna, Ospedale Santa Chiara, Pisa, Toscana, Italy.
Int J Low Extrem Wounds. 2023 Jun;22(2):307-313. doi: 10.1177/15347346211009427. Epub 2021 Apr 28.
This study retrospectively analyzes all consecutive patients who underwent during a year hospital readmissions, defined as an admission to a hospital within 30 days of discharge, to an Italian Internal Medicine ward. All these data were compared with those from patients who underwent only 1 hospital admission in the same period. The aim of this study was to identify potential novel risk factors for hospital readmissions. In 2018, a total of 3012 patients were hospitalized. Among these, 14.1% (n = 426; mean age, 79.7 ± 11.9; range, 23-100) were defined as readmissions; data were compared with controls (n = 420; 13.9%; mean age, 75.9 ± 14.7; range, 22-99) who had only 1 hospitalization. Cases showed a significantly higher prevalence than controls regarding cerebrovascular disease (77.2% vs 48.1%), cognitive impairment (51.8% vs 26.9%), congestive heart failure (47.6% vs 20.2%), chronic kidney disease (31.7% vs 13.1%), and chronic obstructive pulmonary disease (23.0% vs 14.5%). Skin ulcers were significantly more prevalent among cases (45.1% vs 17.6%). Diagnosis-related group (DRG) analysis showed a higher proportion of "infectious disease" (24.4% vs 15.0%) among the cases than in controls. Despite skin ulcers were very frequent among cases and controls (45.1% vs 17.6%), they were codified as "skin wound" DRG only in 1.4% and 0.2%, respectively. At the DRGs analysis, sepsis (31.6% vs 19.1%), pneumonia (17.1% vs 7.6%), and kidney failure (9.6% vs 3.8%) represented the main significant cause of death in cases compared to controls. Our study confirms that readmissions to Internal Medicine departments are related to the severity of chronic diseases affecting patients. Skin ulcers are present in about half of patients who will be early readmitted within 30 days, but they are almost never reported in DRGs, so more accurate coding is needed. Key challenges for the future are sepsis prevention measures and investing resources in chronic disease assistance, including skin ulcer chronic management.
本研究回顾性分析了一年内连续入住意大利内科病房的所有患者，医院再入院定义为出院后30天内再次入院。所有这些数据与同期仅入院一次的患者的数据进行了比较。本研究的目的是确定医院再入院的潜在新危险因素。2018年，共有3012名患者住院。其中，14.1%（n = 426；平均年龄79.7±11.9；范围23 - 100）被定义为再入院患者；数据与仅住院一次的对照组（n = 420；13.9%；平均年龄75.9±14.7；范围22 - 99）进行了比较。病例组在脑血管疾病（77.2%对48.1%）、认知障碍（51.8%对26.9%）、充血性心力衰竭（47.6%对20.2%）、慢性肾病（31.7%对13.1%）和慢性阻塞性肺疾病（23.0%对14.5%）方面的患病率显著高于对照组。皮肤溃疡在病例组中更为普遍（45.1%对17.6%）。诊断相关组（DRG）分析显示，病例组中“传染病”的比例高于对照组（24.4%对15.0%）。尽管皮肤溃疡在病例组和对照组中都很常见（45.1%对17.6%），但它们分别仅在1.4%和0.2%的情况下被编码为“皮肤伤口”DRG。在DRG分析中，与对照组相比，脓毒症（31.6%对19.1%）、肺炎（17.1%对7.6%）和肾衰竭（9.6%对3.8%）是病例组主要的显著死亡原因。我们的研究证实，内科再入院与影响患者的慢性疾病严重程度有关。皮肤溃疡在30天内早期再入院的患者中约占一半，但在DRG中几乎从未被报告，因此需要更准确的编码。未来的关键挑战是脓毒症预防措施以及在慢性疾病援助方面投入资源，包括皮肤溃疡的慢性管理。
