Department of Surgery, Boston Medical Center, MA; Boston University Chobanian & Avedisian School of Medicine, MA.
Boston University Chobanian & Avedisian School of Medicine, MA.
Surgery. 2024 Dec;176(6):1703-1710. doi: 10.1016/j.surg.2024.08.012. Epub 2024 Sep 19.
Housing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission.
We conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest.
The study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35-0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78-4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09-3.19, P = .02).
Compared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.
住房状况会影响择期和紧急手术的结果，但在急诊普通外科患者中尚未得到充分研究。本研究调查了住房状况对并发症以及 30 天随访、急诊就诊和急诊普通外科入院后再入院的影响。
我们对 2014 年至 2021 年在一家城市、保障网医院因急诊普通外科诊断入院的成年患者进行了回顾性匹配队列研究。根据年龄、性别、Charlson 合并症指数、诊断和手术状态，患者按 1:2 的比例进行匹配。主要暴露因素为无家可归状况。主要结局为院内并发症。次要结局包括入住重症监护病房、延长住院时间、随访就诊以及 30 天内急诊就诊或计划外再入院。多变量条件逻辑回归用于确定住房状况与感兴趣结局之间的关联。
本研究纳入 531 例患者（177 例无家可归，354 例有住房）。两组患者的并发症、入住重症监护病房或延长住院时间方面无显著差异。无家可归患者门诊随访的可能性较低（比值比，0.54；95%置信区间，0.35-0.85，P=0.008），急诊就诊（比值比，2.72；95%置信区间，1.78-4.14，P<0.001）和再入院（比值比，1.87；95%置信区间，1.09-3.19，P=0.02）的可能性更高。
与有住房的患者相比，患有急诊普通外科疾病的无家可归患者门诊随访的比例较低，在出院后 30 天内使用急诊和再次入院的可能性更高。这表明需要专门的住院后护理，并需要创造性的方法来接触这部分人群。
