Lee Se Won, Elsakr Carol, Holt Jonathan, Ayutyanont Napatkamon
MountainView Hospital, Las Vegas, NV.
HCA Healthcare Graduate Medical Education, Far West Division, Las Vegas, NV.
HCA Healthc J Med. 2024 Mar 29;5(1):11-18. doi: 10.36518/2689-0216.1600. eCollection 2024.
In this study, we aimed to assess the hospital course, outcomes after hospitalization, and predictors of outcomes in patients with ankylosing spondylitis (AS).
We included 1403 patients with AS between 2016 and 2021 who were identified using International Classification of Disease (ICD) codes from a large for-profit healthcare system database. Demographics and clinical characteristics were compared between those who had a favorable outcome, defined as being discharged to home without readmission within 3 months of discharge, versus those who had an unfavorable outcome. A stepwise logistic regression was used to identify demographic and clinical characteristics associated with home discharge and readmission.
The mean age for all AS patients was 56.06 ± 17.01 years, which was younger in the favorable outcome group, and 82.47% of patients were discharged to home after the average length of stay of 3.72 ± 4.09 days, also shorter in the favorable outcome group. Of 1403 patients, 37.56% were readmitted within 3 months of discharge, at a lower rate in the group with home discharge. Opioids were the most commonly used medication during hospitalization (67.07%), prescribed at a lower rate in the favorable outcome group. Medical coverage by Medicare and Medicaid, fall at admission, hospital-acquired anemia, steroid, acetaminophen, muscle relaxant use, and an increased dose of morphine milligram equivalent at discharge were significantly associated with decreased odds of home discharge. Surgical procedures during admission, gastrointestinal complications, discharge to inpatient rehabilitation units, and use of benzodiazepine were associated with an increased risk of readmission within 3 months.
Recognizing factors that put patients with AS at risk of unfavorable outcomes is useful information to improve patient care during hospitalization.
在本研究中，我们旨在评估强直性脊柱炎（AS）患者的住院病程、出院后结局以及结局的预测因素。
我们纳入了2016年至2021年间1403例AS患者，这些患者是从一个大型营利性医疗系统数据库中使用国际疾病分类（ICD）编码识别出来的。比较了结局良好（定义为出院后3个月内出院且未再次入院）的患者与结局不佳的患者的人口统计学和临床特征。采用逐步逻辑回归来确定与出院回家和再次入院相关的人口统计学和临床特征。
所有AS患者的平均年龄为56.06±17.01岁，结局良好组患者年龄更小，82.47%的患者在平均住院3.72±4.09天后出院，结局良好组住院时间也更短。在1403例患者中，37.56%在出院后3个月内再次入院，出院回家组的再次入院率较低。阿片类药物是住院期间最常用的药物（67.07%），结局良好组的使用率较低。医疗保险和医疗补助覆盖、入院时跌倒、医院获得性贫血、类固醇、对乙酰氨基酚、肌肉松弛剂的使用以及出院时吗啡毫克当量剂量增加与出院回家几率降低显著相关。入院期间的手术、胃肠道并发症、转至住院康复病房以及使用苯二氮䓬类药物与3个月内再次入院风险增加相关。
识别使AS患者面临不良结局风险的因素对于改善住院期间的患者护理是有用的信息。
