Howell Thomas Clark, Lumpkin Stephanie, Chaumont Nicole
Department of Surgery, Duke University, Durham, NC.
Department of Surgery, University of North Carolina at Chapel Hill, NC.
IISE Trans Healthc Syst Eng. 2023;13(3):175-181. doi: 10.1080/24725579.2023.2200210. Epub 2023 May 2.
Most current predictive models for risk of readmission were primarily designed from non-surgical patients and often utilize administrative data alone. Models built upon comprehensive data sources specific to colorectal surgery may be key to implementing interventions aimed at reducing readmissions. This study aimed to develop a predictive model for risk of 30-day readmission specific to colorectal surgery patients including administrative, clinical, laboratory, and socioeconomic status (SES) data. Patients admitted to the colorectal surgery service who underwent surgery and were discharged from an academic tertiary hospital between 2017 and 2019 were included. A total of 1549 patients met eligibility criteria for this retrospective split-sample cohort study. The 30-day readmission rate of the cohort was 19.62%. A multivariable logistic regression was developed (C=0.70, 95% CI 0.61-0.73), which outperformed two internationally used readmission risk prediction indices (C=0.58, 95% CI 0.52-0.65) and (C=0.60, 95% CI 0.53-0.66). Tailored surgery-specific readmission models with comprehensive data sources outperform the most used readmission indices in predicting 30-day readmission in colorectal surgery patients. Model performance is improved by using more comprehensive datasets that include administrative and socioeconomic details about a patient, as well as clinical information used for decision-making around the time of discharge.
目前大多数再入院风险预测模型主要是针对非手术患者设计的,且通常仅使用管理数据。基于结直肠手术特定综合数据源构建的模型可能是实施旨在减少再入院干预措施的关键。本研究旨在开发一种针对结直肠手术患者30天再入院风险的预测模型,该模型纳入了管理、临床、实验室和社会经济地位(SES)数据。纳入2017年至2019年间在一家学术型三级医院接受手术并出院的结直肠外科服务患者。共有1549名患者符合这项回顾性拆分样本队列研究的纳入标准。该队列的30天再入院率为19.62%。开发了一个多变量逻辑回归模型(C=0.70,95%置信区间0.61-0.73),其表现优于两个国际上使用的再入院风险预测指数(C=0.58,95%置信区间0.52-0.65)和(C=0.60,95%置信区间0.53-0.66)。在预测结直肠手术患者30天再入院方面,具有综合数据源的量身定制的手术特异性再入院模型优于最常用的再入院指数。通过使用更全面的数据集,包括患者的管理和社会经济细节以及出院时用于决策的临床信息,模型性能得到了改善。