Chidambaram Rama, Apikotoa Sharie, Hicks Rhiannon, Theophilus Mary, Wijesuriya Ruwan
General Surgery, St John of God Midland Public and Private Hospitals, Perth, AUS.
Vascular Surgery, Royal Perth Hospital, Perth, AUS.
Cureus. 2022 Dec 5;14(12):e32209. doi: 10.7759/cureus.32209. eCollection 2022 Dec.
Background Unplanned readmission to the hospital after discharge is a costly issue for healthcare systems and patients. It is a delicate balance between the resolution of the surgical problem and the length of hospital stay. Most studies have focused on readmissions within 28 or 30 days after discharge, despite data showing that many occur early in this period. This study examined the reasons for unplanned readmission within the first day after discharge. Methods A retrospective cohort analysis of readmissions between 1st May 2016 and 1st May 2021 was undertaken by chart review. Readmissions on the "day of" and the "day after" discharge and their respective index admissions were identified via the hospital's patient administration database, webPAS (DXC Technology, USA). Results There were 126 readmissions (0.5%) across 25,119 admissions. Common reasons for readmission were pain (28%, n=35), readmission for the same diagnosis (21%, n=26), surgical site infection (SSI) (11%, n=14), bleeding (11%, n=14) and ileus (6%, n=7). Analysis of index admissions showed that 18/35 readmissions for pain had inadequate pain management based on pain scores, analgesic use and discharge medications and 7/14 readmissions for SSI did not have appropriate treatment of a recognised SSI or did not have antibiotic prophylaxis guidelines adhered to. Fourteen of 26 readmissions for the same diagnosis received just continuation of treatment initiated at index admission. Conclusion Pain is the most common reason for readmission within the first day after discharge in surgical patients. Better pain management, following antibiotic prophylaxis guidelines, and involving patients in discharge planning could prevent many readmissions.
出院后意外再次入院对医疗系统和患者来说都是一个成本高昂的问题。这是手术问题解决与住院时间之间的微妙平衡。尽管数据显示许多再入院情况发生在出院后早期，但大多数研究都集中在出院后28天或30天内的再入院情况。本研究调查了出院后第一天内意外再入院的原因。
通过病历审查对2016年5月1日至2021年5月1日期间的再入院情况进行回顾性队列分析。通过医院的患者管理数据库webPAS（美国DXC技术公司）确定出院“当天”和“次日”的再入院情况及其各自的首次入院情况。
在25119例入院病例中，有126例再入院（0.5%）。再入院的常见原因包括疼痛（28%，n = 35）、因相同诊断再次入院（21%，n = 26）、手术部位感染（SSI）（11%，n = 14）、出血（11%，n = 14）和肠梗阻（6%，n = 7）。对首次入院情况的分析表明，35例因疼痛再入院的患者中，有18例基于疼痛评分、镇痛药物使用和出院用药情况，疼痛管理不充分；14例因SSI再入院的患者中，有7例对已确诊的SSI没有进行适当治疗，或未遵守抗生素预防指南。26例因相同诊断再入院的患者中，有14例只是继续了首次入院时开始的治疗。
疼痛是外科患者出院后第一天内再入院的最常见原因。更好的疼痛管理、遵循抗生素预防指南以及让患者参与出院计划可以预防许多再入院情况。
