Gratsianskiy Denis, Patel Dharti, Sucandy Iswanto, Pattilachan Tara M, Christodoulou Maria, Rosemurgy Alexander, Ross Sharona B
Foregut and HPB Division, Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA.
J Robot Surg. 2024 Dec 11;19(1):20. doi: 10.1007/s11701-024-02186-0.
This study sought to identify the primary reasons for hospital readmissions and examine patient outcomes and associated costs following readmission after robotic pancreaticoduodenectomy. We conducted a retrospective analysis of 435 patients who underwent robotic pancreaticoduodenectomy between 2012 and 2024. Readmitted patients within 30 days post-surgery were compared to non-readmitted patients using Student's t-test and Fisher's exact test. Data are presented as median (mean ± SD). In the study cohort, 86 patients (20%) were readmitted within 30 days after surgery. No significant differences were found in patient demographics or outcomes. The most common causes for readmission included insufficient patient education (n = 18), infection (n = 16), and gastrointestinal bleeding (n = 13). The readmitted cohort had significantly higher costs at $40,452 (± 30,724) compared to $31,438 (± 31,546.2) for non-readmitted patients (p < 0.001). Median survival was similar between the two groups (36 vs. 34 months, p = 0.88). Although some readmissions are inevitable, this study provides compelling evidence that inadequate patient education is a primary contributor to increased healthcare costs. The lack of sufficient education appears to have no mitigating effect on patient outcomes. Implementing a proactive, thorough patient education approach, combined with improved emergency department awareness, presents a promising strategy for reducing costly readmissions.
本研究旨在确定医院再入院的主要原因，并检查机器人胰十二指肠切除术后再入院后的患者结局及相关费用。我们对2012年至2024年间接受机器人胰十二指肠切除术的435例患者进行了回顾性分析。采用学生t检验和Fisher精确检验，将术后30天内再入院的患者与未再入院的患者进行比较。数据以中位数（均值±标准差）表示。在研究队列中，86例患者（20%）在术后30天内再入院。患者人口统计学特征或结局方面未发现显著差异。再入院的最常见原因包括患者教育不足（n = 18）、感染（n = 16）和胃肠道出血（n = 13）。再入院队列的费用显著更高，为40,452美元（±30,724），而非再入院患者为31,438美元（±31,546.2）（p < 0.001）。两组的中位生存期相似（36个月对34个月，p = 0.88）。尽管有些再入院是不可避免的，但本研究提供了令人信服的证据，表明患者教育不足是医疗费用增加的主要原因。缺乏充分教育似乎对患者结局没有缓解作用。实施积极、全面的患者教育方法，同时提高急诊科的意识，是减少代价高昂的再入院的一个有前景的策略。
