Fan Rui, Chen Qifeng, Gao Shang, Wang Lili, Mao Shuqi, Yan Zhiyu
Medical Quality Management Office, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
Medical Administration Division, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
Ann Med. 2025 Dec;57(1):2473633. doi: 10.1080/07853890.2025.2473633. Epub 2025 Mar 4.
The issue of unplanned reoperations poses significant challenges within healthcare systems, with assessing their impact being particularly difficult. The current study aimed to assess the influence of unplanned reoperations on hospitalized patients by employing the diagnosis-related group (DRG) to comprehensively consider the intensity and complexity of different medical services.
A retrospective cohort study of surgical patients was conducted at a large tertiary hospital with two hospital districts employing data sourced from a DRG database. Hospital length of stay (LOS) and hospitalization costs were measured as the primary outcomes. Discharge to home was measured as the secondary outcome. Frequency matching based on DRG, regression modeling, subgroup comparison and sensitivity analysis were applied to evaluate the influence of unplanned reoperations.
We identified 20820 surgical patients distributed across 79 DRGs, including 188 individuals who underwent unplanned reoperations and 20632 normal surgical patients in the same DRGs. After DRG-based frequency matching, 564 patients (188 with unplanned reoperations, 376 normal surgical patients) were included. Unplanned reoperations led to prolonged LOS (before matching: adjusted difference, 12.05 days, 95% confidence interval [CI] 10.36-13.90 days; after matching: adjusted difference, 14.22 days, 95% CI 11.36-17.39 days), and excess hospitalization costs (before matching: adjusted difference, $4354.29, 95% CI: $3,817.70-$4928.67; after matching: adjusted difference, $5810.07, 95% CI $4481.10-$7333.09). Furthermore, patients who underwent unplanned reoperations had a reduced likelihood of being discharged to home (before matching: hazard ratio [HR] 0.27, 95% CI 0.23-0.32; after matching: HR 0.31, 95% CI 0.25-0.39). Subgroup analyses indicated that the outcomes across the various subgroups were mostly uniform. In high-level surgery subgroups (levels 3-4) and in relation to complex diseases (relative weight ≥ 2), the increase in hospitalization costs and LOS was more pronounce after unplanned reoperations. Similar results were observed with sensitivity analysis by propensity score matching and excluding short LOS.
Incorporating the DRG allows for a more effective assessment of the influence of unplanned reoperations. In managing such reoperations, mitigating their influence, especially in the context of high-level surgeries and complex diseases, remains a significant challenge that requires special consideration.
计划外再次手术问题给医疗系统带来了重大挑战，评估其影响尤其困难。本研究旨在通过运用诊断相关分组（DRG）全面考量不同医疗服务的强度和复杂性，评估计划外再次手术对住院患者的影响。
在一家拥有两个院区的大型三级医院，对手术患者进行回顾性队列研究，数据来源于DRG数据库。将住院时间（LOS）和住院费用作为主要结局指标进行测量。将出院回家作为次要结局指标进行测量。应用基于DRG的频率匹配、回归建模、亚组比较和敏感性分析来评估计划外再次手术的影响。
我们识别出20820例分布在79个DRG中的手术患者群体，其中包括188例接受计划外再次手术的患者以及同一DRG中的20632例常规手术患者。在基于DRG的频率匹配后，纳入了564例患者（188例计划外再次手术患者，376例常规手术患者）。计划外再次手术导致住院时间延长（匹配前：调整差异为12.05天，95%置信区间[CI]为10.36 - 13.90天；匹配后：调整差异为14.22天，95% CI为11.36 - 17.39天），以及住院费用增加（匹配前：调整差异为4354.29美元，95% CI：3817.70美元 - 4928.67美元；匹配后：调整差异为5810.07美元，95% CI为4481.10美元 - 7333.09美元）。此外，接受计划外再次手术的患者出院回家的可能性降低（匹配前：风险比[HR]为0.27，95% CI为0.23 - 0.32；匹配后：HR为0.31，95% CI为0.25 - 0.39）。亚组分析表明，各个亚组的结果大多一致。在高难度手术亚组（3 - 4级）以及与复杂疾病相关的亚组（相对权重≥2）中，计划外再次手术后住院费用和住院时间的增加更为明显。通过倾向得分匹配和排除短住院时间进行敏感性分析时也观察到了类似结果。
纳入DRG能够更有效地评估计划外再次手术的影响。在管理此类再次手术时，减轻其影响，尤其是在高难度手术和复杂疾病的背景下，仍然是一项重大挑战，需要特别关注。
