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多中心数据库中 CABG 术后 30 天内再入院的预测因素:一项横断面研究。

Predictors of 30-Day Hospital Readmission Following CABG in a Multicenter Database: A Cross-Sectional Study.

机构信息

Hospital João XXIII, Santarém, PA - Brasil.

Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.

出版信息

Arq Bras Cardiol. 2024 Sep 6;121(9):e20230768. doi: 10.36660/abc.20230768. eCollection 2024.

Abstract

BACKGROUND

The analysis of indicators such as hospital readmission rates is crucial for improving the quality of services and management of hospital processes.

OBJECTIVES

To identify the variables correlated with hospital readmission up to 30 days following coronary artery bypass grafting (CABG).

METHODS

Cross-sectional cohort study by REPLICCAR II database (N=3,392) from June 2017 to June 2019. Retrospectively, 150 patients were analyzed to identify factors associated with hospital readmission within 30 days post-CABG using univariate and multivariate logistic regression. Analysis was conducted using software R, with a significance level of 0.05 and 95% confidence intervals.

RESULTS

Out of 3,392 patients, 150 (4,42%0 were readmitted within 30 days post-discharge from CABG primarily due to infections (mediastinitis, surgical wounds, and sepsis) accounting for 52 cases (34.66%). Other causes included surgical complications (14/150, 9.33%) and pneumonia (13/150, 8.66%). The multivariate regression model identified an intercept (OR: 1.098, p<0.00001), sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) as predictors of the outcome, with an AUC of 0.70.

CONCLUSION

4.42% of patients were readmitted post-CABG, mainly due to infections. Factors such as sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) were predictors of readmission, with moderate risk discrimination (AUC: 0.70).

摘要

背景

分析医院再入院率等指标对于提高服务质量和医院流程管理至关重要。

目的

确定与冠状动脉旁路移植术(CABG)后 30 天内医院再入院相关的变量。

方法

这是一项来自 2017 年 6 月至 2019 年 6 月期间 REPLICCAR II 数据库的横断面队列研究(N=3392)。回顾性分析了 150 例患者,采用单因素和多因素逻辑回归分析识别 CABG 后 30 天内与医院再入院相关的因素。使用软件 R 进行分析,显著性水平为 0.05 和 95%置信区间。

结果

在 3392 例患者中,有 150 例(4.42%)在 CABG 出院后 30 天内再次入院,主要原因是感染(纵隔炎、手术伤口和败血症),占 52 例(34.66%)。其他原因包括手术并发症(150 例中有 14 例,9.33%)和肺炎(150 例中有 13 例,8.66%)。多变量回归模型确定截距(OR:1.098,p<0.00001)、睡眠呼吸暂停(OR:1.117,p=0.0165)、心律失常(OR:1.040,p=0.0712)和主动脉内球囊泵使用(OR:1.068,p=0.0021)是该结果的预测因素,AUC 为 0.70。

结论

CABG 后 4.42%的患者再次入院,主要原因是感染。睡眠呼吸暂停(OR:1.117,p=0.0165)、心律失常(OR:1.040,p=0.0712)和主动脉内球囊泵使用(OR:1.068,p=0.0021)等因素是再入院的预测因素,风险判别能力中等(AUC:0.70)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1c6f/11495644/badd8a054477/0066-782X-abc-121-09-e20230768-gf01.jpg

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