Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Neurointerv Surg. 2023 Mar;15(3):242-247. doi: 10.1136/neurintsurg-2021-018523. Epub 2022 Feb 15.
Hospital readmissions are costly and reflect negatively on care delivered.
To have a better understanding of unplanned readmissions after carotid revascularization, which might help to prevent them.
The Nationwide Readmissions Database was used to determine rates and reasons for unplanned readmission following carotid endarterectomy (CEA) and carotid artery stenting (CAS). Trends were assessed by annual percent change, modified Poisson regression was used to estimate risk ratios (RR) for readmission, and propensity scores were used to match cohorts.
Analysis yielded 522 040 asymptomatic and 55 485 symptomatic admissions for carotid revascularization between 2010 and 2015. Higher 30-day readmission rates were noted after CAS versus CEA in both symptomatic (9.1% vs 7.7%, p<0.001) and asymptomatic (6.8% vs 5.7%, p<0.001) patients. Readmission rates trended lower over time, significantly so for 90-day readmissions in symptomatic patients undergoing CEA. The most common cause for 30-day readmission was stroke in both symptomatic (5.5%) and asymptomatic (3.9%) patients. Factors associated with a higher risk of readmission included age over 80; male gender; Medicaid health insurance; and increases in severity of illness, mortality risk, and comorbidity indices. Analysis of matched cohorts showed that CAS had higher readmission than CEA (RR=1.14 (95% CI 1.06 to 1.22); p<0.001) only in asymptomatic patients. Adverse events during initial admission which predicted 30-day readmission included acute renal failure and acute respiratory failure in asymptomatic patients; hematoma and cardiac events were additional predictive adverse events in symptomatic patients.
Readmission is not uncommon after carotid revascularization, occurs more often after CAS, and is predicted by baseline factors and by preventable adverse events at initial admission.
医院再入院费用高昂，反映了医疗服务的不足。
更好地了解颈动脉血运重建术后非计划性再入院的情况，以便进行预防。
利用全国再入院数据库，确定颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）后非计划性再入院的发生率和原因。通过年度百分比变化评估趋势，采用修正泊松回归估计再入院的风险比（RR），并使用倾向评分匹配队列。
2010 年至 2015 年期间，分析得出 522040 例无症状和 55485 例有症状的颈动脉血运重建患者。在有症状（9.1% vs. 7.7%，p<0.001）和无症状（6.8% vs. 5.7%，p<0.001）患者中，CAS 的 30 天再入院率均高于 CEA。随着时间的推移，再入院率呈下降趋势，CEA 治疗的有症状患者的 90 天再入院率显著下降。30 天再入院的最常见原因是卒中，无论是在有症状（5.5%）还是无症状（3.9%）患者中。与再入院风险增加相关的因素包括年龄超过 80 岁；男性；医疗补助健康保险；以及严重程度、死亡率和合并症指数的增加。匹配队列分析显示，在无症状患者中，CAS 的再入院率高于 CEA（RR=1.14（95%CI 1.06 至 1.22）；p<0.001）。初始住院期间预测 30 天再入院的不良事件包括无症状患者的急性肾衰竭和急性呼吸衰竭；有症状患者的血肿和心脏事件是其他预测不良事件。
颈动脉血运重建后再入院并不少见，CAS 后更常见，且可由基线因素和初始住院期间可预防的不良事件预测。
