Beggs V L, Birkemeyer N J, Nugent W C, Dacey L J, O'Connor G T
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Best Pract Benchmarking Healthc. 1996 Jul-Aug;1(4):180-6.
Early rehospitalization after coronary artery bypass grafting (CABG) is an expensive and frequently adverse outcome. Rehospitalization rates after various surgical procedures have been used as an indicator of quality of care. Determining the extent to which rehospitalization rates reflect patient case mix and severity of illness rather than quality of care requires detailed information regarding the patients, the care they received, and the reasons for their rehospitalization.
We conducted a nested case control study comparing 110 CABG patients who were rehospitalized within 30 days after discharge with 224 control patients. Control patients were randomly selected from patients undergoing CABG during the same time frame as the cases and were matched on age, gender, and priority of surgery. A detailed chart review provided information regarding treatment in the postsurgical period, in addition to the preoperative information collected on all CABG patients as part of an ongoing regional prospective study.
The overall rehospitalization rate was 13.8%. The most common reasons for rehospitalization included: wound infection (19%), atrial fibrillation (13%), pleural effusion (11%), and thromboembolic event (10%). Preoperative severity of illness and comorbidity accounted for 24% of the total variance. After adjustment for these factors, discharge hematocrit less than 30% (OR = 2.01, p = 0.018) and several discharge medications including: antiarrhythmics (OR = 3.26, p = 0.047), diuretics (OR = 2.18, p = 0.055), beta blockers (OR = 0.44, p = 0.036), and long length of stay (more than 7 days; OR = 2.09, p = 0.029) were the most important predictors of rehospitalization risk.
Although the reasons for rehospitalization after CABG are heterogeneous and related to patient severity of illness as well as comorbid status, several of the most common are potentially preventable and related to quality of care. Rehospitalization was not related to early discharge.
冠状动脉旁路移植术（CABG）后早期再次住院是一种昂贵且常见的不良结局。各种外科手术的再住院率已被用作医疗质量的指标。确定再住院率在多大程度上反映患者病例组合和疾病严重程度而非医疗质量，需要有关患者、他们接受的治疗以及再住院原因的详细信息。
我们进行了一项巢式病例对照研究，将110例出院后30天内再次住院的CABG患者与224例对照患者进行比较。对照患者是从与病例同期接受CABG的患者中随机选取的，并在年龄、性别和手术优先级方面进行匹配。除了作为正在进行的区域前瞻性研究的一部分收集的所有CABG患者的术前信息外，详细的病历审查还提供了术后治疗的信息。
总体再住院率为13.8%。再住院的最常见原因包括：伤口感染（19%）、心房颤动（13%）、胸腔积液（11%）和血栓栓塞事件（10%）。术前疾病严重程度和合并症占总变异的24%。在对这些因素进行调整后，出院时血细胞比容低于30%（OR = 2.01，p = 0.018）以及几种出院用药，包括：抗心律失常药（OR = 3.26，p = 0.047）、利尿剂（OR = 2.18，p = 0.055）、β受体阻滞剂（OR = 0.44，p = 0.036）以及住院时间长（超过7天；OR = 2.09，p = 0.029）是再住院风险的最重要预测因素。
虽然CABG后再住院的原因是多方面的，且与患者疾病严重程度以及合并症状态有关，但一些最常见的原因是潜在可预防的，且与医疗质量有关。再住院与早期出院无关。
