Amirkhosravi Farshad, Nguyen Duc T, Del Rio Roberto Secchi, Graviss Edward A, Fida Nadia, Guha Ashrith, Martin Cindy, Suarez Eric, Chou Lin-Chiang Philip, Bhimaraj Arvind
Division of General Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Texas.
Department of Pediatrics, Baylor College Medicine, Houston, Texas.
JHLT Open. 2024 Mar 26;4:100085. doi: 10.1016/j.jhlto.2024.100085. eCollection 2024 May.
This study showcases an analysis performed using the National Readmission Database (NRD) from 2016 to 2019 to analyze the impact of ownership, location, size, and teaching status of transplant centers on cardiac transplant outcomes.
Demographic variables and hospital characteristics were identified using NRD data and International Classification of Diseases,10th revision codes. Comorbidities were assessed using the Elixhauser comorbidity index. Multivariable linear and logistic regression analyses were used to assess in-hospital mortality, 30-day and 180-day readmission rates, length of stay, days from admission to procedure, transfer to a rehab center, graft rejection, graft failure, and index admission total cost.
Most cardiac transplants occurred in privately owned, large metropolitan areas, large bed size, and teaching centers. No significant difference was seen in in-hospital mortality, graft rejection, or graft failure by hospital ownership, location, size, or teaching status. Patients in private hospitals were more likely to be readmitted at 180 days and less likely to be transferred to rehab center compared to government-owned hospitals. Patients in private, small bed size, and teaching centers were more likely to have shorter length of stay. Additionally, days of admission to procedure were shorter in small bed size and teaching centers. Furthermore, the cost of index-hospital stay was higher in privately owned, large metropolitan areas, large bed size, and teaching centers.
While in-hospital mortality was not significantly different, various other outcomes related to cost and efficiency seem to be impacted by hospital characteristics.
本研究展示了一项分析，该分析使用2016年至2019年的国家再入院数据库（NRD）来分析移植中心的所有权、位置、规模和教学状况对心脏移植结果的影响。
使用NRD数据和国际疾病分类第10版编码确定人口统计学变量和医院特征。使用埃利克斯豪泽合并症指数评估合并症。多变量线性和逻辑回归分析用于评估住院死亡率、30天和180天再入院率、住院时间、入院至手术天数、转至康复中心情况、移植排斥反应、移植失败以及首次入院总成本。
大多数心脏移植发生在私立、大都市地区、床位规模大的教学中心。医院的所有权、位置、规模或教学状况在住院死亡率、移植排斥反应或移植失败方面未见显著差异。与公立医院相比，私立医院的患者在180天时更有可能再次入院，且转至康复中心的可能性更小。私立、床位规模小的教学中心的患者住院时间更有可能较短。此外，床位规模小的教学中心入院至手术的天数较短。此外，私立、大都市地区、床位规模大的教学中心首次住院的费用更高。
虽然住院死亡率没有显著差异，但与成本和效率相关的其他各种结果似乎受到医院特征的影响。
