Pavurala Ravi B, Stanich Peter P, Krishna Somashekar G, Guturu Praveen, Hinton Alice, Conwell Darwin L, Balasubramanian Gokulakrishnan
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Neurogastroenterol Motil. 2021 Jul 30;27(3):408-418. doi: 10.5056/jnm20105.
BACKGROUND/AIMS: Gastroparesis is a chronic gastrointestinal disorder that frequently presents with symptoms that are difficult to manage, necessitating frequent hospitalizations. We sought to determine the predictors of early readmission due to gastroparesis based on etiology.
We identified all adults discharged with a principal diagnosis of gastroparesis after hospitalization from the 2014 Nationwide Readmission Database. We compared etiology wise (diabetes, post-surgical, and idiopathic) early readmission. Multivariate regression analyses were performed to identify significant predictors of 30-day readmission.
A total of 12 689 patients were identified, 30.7% diabetic, 2.6% post-surgical, and 66.7% were idiopathic. Patients with diabetic gastroparesis were more likely to be readmitted within 30 days than idiopathic (adjusted odds ratio [aOR], 0.81; 95% confidence interval [CI], 0.69-0.94) and post-surgical gastroparesis (aOR, 0.58; 95% CI, 0.34-0.98). Pyloroplasty was associated with less likelihood of 30-day readmission (aOR, 0.45; 95% CI, 0.20-0.97). In addition, male gender (aOR, 1.18; 95% CI, 1.02-1.37), modified Elixhauser comorbidity score ≥ 3 (aOR, 1.38; 95% CI, 1.18-1.61), chronic pain syndrome (aOR, 1.41; 95% CI, 1.11-1.78), younger (18-64 years) age (aOR, 1.64; 95% CI, 1.34-2.00), need for percutaneous endoscopic gastrostomy/jejunostomy tube (aOR, 2.06; 95% CI, 1.21-3.52), and need for total parenteral nutrition (aOR, 1.70; 95% CI, 1.24-2.35) were associated with increased risk of 30-day readmission.
s One in 5 patients was readmitted with gastroparesis within 30 days. In the diabetic group, diabetes-related complications contributed to readmissions than gastroparesis. Pyloroplasty is associated with reduced early hospital readmission. Prospective studies are needed for validation of these results.
背景/目的：胃轻瘫是一种慢性胃肠道疾病，常出现难以控制的症状，需要频繁住院治疗。我们试图根据病因确定因胃轻瘫导致早期再入院的预测因素。
我们从2014年全国再入院数据库中确定了所有因胃轻瘫主要诊断而住院后出院的成年人。我们比较了不同病因（糖尿病、手术后和特发性）的早期再入院情况。进行多变量回归分析以确定30天再入院的重要预测因素。
共确定了12689例患者，其中30.7%为糖尿病性，2.6%为手术后，66.7%为特发性。糖尿病性胃轻瘫患者比特发性（调整优势比[aOR]，0.81；95%置信区间[CI]，0.69 - 0.94）和手术后胃轻瘫患者（aOR，0.58；95% CI，0.34 - 0.98）更有可能在30天内再次入院。幽门成形术与30天再入院的可能性较小相关（aOR，0.45；95% CI，0.20 - 0.97）。此外，男性（aOR，1.18；95% CI，1.02 - 1.37）、改良埃利克斯豪泽合并症评分≥3（aOR，1.38；95% CI，1.18 - 1.61）、慢性疼痛综合征（aOR，1.41；95% CI，1.11 - 1.78）、较年轻（18 - 64岁）年龄（aOR，1.64；95% CI，1.34 - 2.00）、需要经皮内镜胃造口术/空肠造口术管（aOR，2.06；95% CI，1.21 - 3.52）以及需要全胃肠外营养（aOR，1.70；95% CI，1.24 - 2.35）与30天再入院风险增加相关。
五分之一的患者在30天内因胃轻瘫再次入院。在糖尿病组中，与糖尿病相关的并发症导致再入院的情况比胃轻瘫更多。幽门成形术与早期医院再入院率降低相关。需要进行前瞻性研究以验证这些结果。
