Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: https://twitter.com/EmanueleLagazzi.
Surgery. 2024 Sep;176(3):949-954. doi: 10.1016/j.surg.2024.05.017. Epub 2024 Jun 14.
Care fragmentation has been shown to lead to increased morbidity and mortality. We aimed to explore the factors related to care fragmentation after hospital discharge in geriatric emergency general surgery patients, as well as examine the association between care fragmentation and mortality.
We designed a retrospective study of the Nationwide Readmissions Database 2019. We included patients ≥65 years old admitted with an emergency general surgery diagnosis who were discharged alive from the index admission. The primary outcome was 90-day care fragmentation, defined as an unplanned readmission to a non-index hospital. Multivariable logistic regression was performed, adjusting for patient and hospital characteristics.
A total of 447,027 older adult emergency general surgery patients were included; the main diagnostic category was colorectal (22.6%), and 78.2% of patients underwent non-operative management during the index hospitalization. By 90 days post-discharge, 189,622 (24.3%) patients had an unplanned readmission. Of those readmitted, 20.8% had care fragmentation. The median age of patients with care fragmentation was 76 years, and 53.2% were of female sex. Predictors of care fragmentation were living in rural counties (odds ratio 1.76, 95% confidence interval: 1.57-1.97), living in a low-income ZIP Code, discharge to intermediate care facility (odds ratio 1.28, 95% confidence interval: 1.22-1.33), initial non-operative management (odds ratio 1.17, 95% confidence interval: 1.12-1.23), leaving against medical advice (odds ratio 2.60, 95% confidence interval: 2.29-2.96), and discharge from private investor-owned hospitals (odds ratio 1.18, 95% confidence interval: 1.10-1.27). Care fragmentation was significantly associated with higher mortality.
The burden of unplanned readmissions in older adult patients who survive an emergency general surgery admission is underestimated, and these patients frequently experience care fragmentation. Future directions should prioritize evaluating the impact of initiatives aimed at alleviating the incidence and complications of care fragmentation in geriatric emergency general surgery patients.
已有研究表明，护理碎片化会导致发病率和死亡率上升。我们旨在探讨老年急诊普外科患者出院后护理碎片化的相关因素，并研究护理碎片化与死亡率之间的关系。
我们设计了一项对 2019 年全国再入院数据库的回顾性研究。我们纳入了年龄≥65 岁、因急诊普外科诊断入院且首次住院期间存活出院的患者。主要结局为 90 天护理碎片化，定义为非索引医院的非计划性再入院。采用多变量逻辑回归调整患者和医院特征。
共纳入 447027 名老年急诊普外科患者，主要诊断类别为结直肠（22.6%），78.2%的患者在指数住院期间接受非手术治疗。出院后 90 天内，有 189622（24.3%）名患者发生非计划性再入院。其中 20.8%的患者发生护理碎片化。发生护理碎片化的患者中位年龄为 76 岁，53.2%为女性。护理碎片化的预测因素包括居住在农村县（比值比 1.76，95%置信区间：1.57-1.97）、居住在低收入 ZIP 码、出院至中级护理机构（比值比 1.28，95%置信区间：1.22-1.33）、初始非手术治疗（比值比 1.17，95%置信区间：1.12-1.23）、出院时违背医嘱（比值比 2.60，95%置信区间：2.29-2.96）和从私营投资者所有的医院出院（比值比 1.18，95%置信区间：1.10-1.27）。护理碎片化与死亡率显著相关。
在存活的老年急诊普外科患者中，未计划再入院的负担被低估，这些患者经常经历护理碎片化。未来的研究方向应优先评估旨在减轻老年急诊普外科患者护理碎片化发生率和并发症的各项措施的影响。
