Readmission After Resections of the Colon and Rectum: Predictors of a Costly and Common Outcome
Readmission After Resections of the Colon and Rectum: Predictors of a Costly and Common Outcome
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DOI：
10.1097/dcr.0000000000000433
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发表时间：
2015-12-01
影响因子：
3.9
通讯作者：
Tseng, Jennifer F.
中科院分区：
文献类型：
--
作者：
Bliss, Lindsay A.;Maguire, Lillias H.;Tseng, Jennifer F.
背景：再住院率是手术质量的衡量标准，也是临床和监管审查的对象。尽管不断努力提高质量和控制成本，6%到25%的患者在结直肠手术后再次入院。目的：这项研究的目的是确定结直肠手术后再次入院的预测因素和成本。设计：这是一项在2007至2011年的医疗保健成本和利用项目佛罗里达州住院数据库中对接受选择性和非选择性结肠切除和/或直肠切除的患者进行的回顾性队列研究。再入院定义为出院后30天内住院。单因素分析包括性别、年龄、Elixhauser评分、种族、保险类型、手术方式、适应症、再入院诊断、费用和住院时间。多因素分析采用Logistic回归分析。对非急诊入院的敏感性进行分析。设置：本研究在佛罗里达州的急诊医院进行。患者：纳入2007年至2011年接受结肠切除和直肠切除术的患者。干预(S)：没有干预。主要结果衡量(S)：测量的主要结果是再入院和再入院的费用。结果：共有93,913名患者接受结肠切除，14.7%的患者在30天内再次入院。从2007年到2011年，再住院率保持稳定(14.6%-14.2%，趋势p=0.1585)。经多因素调整后，与再入院相关的患者因素包括非白人种族、年龄
BACKGROUND: Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6% to 25% of patients are readmitted after colorectal surgery.OBJECTIVE: The aim of this study is to define the predictors and costs of readmission following colorectal surgery.DESIGN: This is a retrospective cohort study of patients undergoing elective and nonelective colectomy and/or proctectomy in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007 to 2011. Readmission is defined as inpatient admission within 30 days of discharge. Univariate analyses were performed of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis was performed by logistic regression. Sensitivity analysis of nonemergent admissions was conducted.SETTINGS: This study was conducted in Florida acute-care hospitals.PATIENTS: Patients undergoing colectomy and proctectomy from 2007 to 2011 were included.INTERVENTION(S): There were no interventions.MAIN OUTCOME MEASURE(S): The primary outcomes measured were readmission and the cost of readmission.RESULTS: A total of 93,913 patients underwent colectomy; 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6%-14.2%, trend p = 0.1585). After multivariate adjustment, patient factors associated with readmission included nonwhite race, age