Office of Student Affairs, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
Section of Critical Care, Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, USA.
Pediatr Cardiol. 2021 Aug;42(6):1449-1456. doi: 10.1007/s00246-021-02631-z. Epub 2021 May 11.
Medically complex children including infants undergoing cardiac surgery are at increased risk for hospital readmissions. Investigation of this population may reveal opportunities to optimize systems and coordination of care. A retrospective study of all infants undergoing cardiac surgery from 2015 through 2016 at a large tertiary institution who were readmitted within 1 year of discharge from cardiac surgical hospitalization was performed. Data specific to patient characteristics, surgical hospitalization, and readmission hospitalization are described. Unplanned readmissions within 1 year of hospital discharge were analyzed with Cox proportional hazard regression to identify factors associated with increased hazard for earlier unplanned readmission. Comparable to previous reports, 12% (78/658) of all surgical hospitalizations were associated with unplanned readmission within 30 days. Infectious etiology, followed by cardiac and gastrointestinal problems, was the most common reasons for unplanned 30-day readmission. Unplanned readmissions within 2 weeks of discharge were multifactorial and less commonly related to cardiac or surgical care. Primary nasogastric tube feeding at the time of discharge was the only significant risk factor for earlier unplanned readmission (p = 0.032) on multivariable analysis. Increased care coordination with particular attention to feeding and comorbidity management may be future targets to effectively mitigate readmissions and improve quality of care in this population.
患有心脏疾病且病情复杂的儿童（包括婴儿）在接受心脏手术后，再次住院的风险增加。对该人群进行研究可能会发现优化系统和协调护理的机会。对一家大型三级医疗机构在 2015 年至 2016 年期间接受心脏手术的所有婴儿进行了回顾性研究，这些婴儿在心脏外科住院治疗出院后 1 年内再次住院。描述了与患者特征、外科住院和再次入院住院相关的数据。使用 Cox 比例风险回归分析对出院后 1 年内的非计划性再入院进行分析，以确定与更早的非计划性再入院风险增加相关的因素。与之前的报告类似，所有外科住院治疗中有 12%（78/658）在 30 天内出现非计划性再入院。感染病因，其次是心脏和胃肠道问题，是 30 天内非计划性再入院的最常见原因。出院后 2 周内的非计划性再入院是多因素的，与心脏或外科护理的关系不太常见。多变量分析显示，出院时进行鼻胃管喂养是更早发生非计划性再入院的唯一显著危险因素（p=0.032）。增加护理协调，特别是关注喂养和合并症管理，可能是未来减轻该人群再入院率和提高护理质量的目标。
