Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery
Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery
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DOI：
10.1001/jamasurg.2016.1258
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发表时间：
2016-09-01
期刊：
影响因子：
16.9
通讯作者：
Maier, Ronald V.
中科院分区：
文献类型：
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作者：
McIntyre, Lisa K.;Arbabi, Saman;Maier, Ronald V.
重要性以前调查有再次住院风险的患者的研究集中在医疗服务上，并发现慢性病是促成因素。目的对出院后30天内再次入院的外科患者进行分析，以确定在可能与医学人群不同的队列中进行干预的机会。设计、设置和参与者回顾2014年7月1日至2015年6月30日期间普通外科服务出院后30天内再次入院的患者的病历，以表征指标和再入院数据。在I级创伤中心和安全网医院。主要结果和衡量再次入院的原因通过手工病历回顾确定的原因和通过统计分析在此期间所有出院的所有出院的风险因素。结果在2 100例出院的患者中有173例在30天内被确认为计划外再入院(8.2%)。在这173名患者中，91名是男性。再次住院的常见原因包括29例注射毒品患者因软组织感染在新的部位再次入院(16.8%)，25例(14.5%)有处置支持问题，23例(13.3%)在指数入院时未发现感染，16例(9.2%)有损伤或病情的后遗症。16名患者被确定为可能有可预防的护理并发症(9.2%)，2名患者因医疗条件恶化而再次入院(1.2%)。在单变量和多变量分析中，女性(男性与女性再入院的风险比[OR]，0.5；95%CI，0.37-0.71；P<；.001)，糖尿病的存在(OR，1.7；95%CI，1.1-2.6；P=.009)，入院时的脓毒症(OR，1.7；95%CI，1.05-2.6；P=.03)，或在指数入院期间住重症监护病房(OR，1.7；95%CI，1.2-2.4；P=.002)，以及出院后接受暂缓治疗(OR，2.3；95%CI，1.2-4.5；P=.01)和付款人身份(与商业OR相比，Medicaid/Medicare，2.0；95%CI，1.3-3.0；P=.002)，被确定为再次入院的危险因素。虽然医疗并存是有原因的，但大量的再入院并不是由不理想的医疗或医疗条件恶化造成的，而是由于药物滥用或无家可归的混乱问题造成的。确定重新入院的最高风险队列可以为具有社会挑战患者的相似人群提供更有针对性的干预。
IMPORTANCE Previous studies investigating patients at risk for hospital readmissions focus on medical services and have found chronic conditions as contributors. Little is known, however, of the characteristics of patients readmitted from surgical services.OBJECTIVE Surgical patients readmitted within 30 days following discharge were analyzed to identify opportunities for intervention in a cohort that may differ from the medical population.DESIGN, SETTING, AND PARTICIPANTS Medical record review of patients readmitted to any service within 30 days of discharge from the general surgery service to characterize index and readmission data between July 1, 2014, and June 30, 2015, at a Level I trauma center and safety-net hospital.MAIN OUTCOMES AND MEASURES Reasons for readmission identified by manual medical record review and risk factors identified via statistical analysis of all discharges during this period.RESULTS One hundred seventy-three patients were identified as being unplanned readmissions within 30 days among 2100 discharges (8.2%). Of these 173 patients, 91 were men. Common reasons for readmission included 29 patients with injection drug use who were readmitted with soft tissue infections at new sites (16.8% of readmissions), 25 with disposition support issues (14.5%), 23 with infections not detectable during index admission (13.3%), and 16 with sequelae of their injury or condition (9.2%). Sixteen patients were identified as having a likely preventable complication of care (9.2%), and 2 were readmitted owing to deterioration of medical conditions (1.2%). On univariate and multivariate analyses, female sex (men to women risk of readmission odds ratio [ OR], 0.5; 95% CI, 0.37-0.71; P < .001), presence of diabetes (OR, 1.7; 95% CI, 1.1-2.6; P = .009), sepsis on admission (OR, 1.7; 95% CI, 1.05-2.6; P = .03), or intensive care unit stay during index admission (OR, 1.7; 95% CI, 1.2-2.4; P = .002), as well as discharge to respite care (OR, 2.3; 95% CI, 1.2-4.5; P = .01) and payer status (Medicaid/Medicare compared with commercial OR, 2.0; 95% CI, 1.3-3.0; P = .002), were identified as risk factors for readmission.CONCLUSIONS AND RELEVANCE Many readmissions may be unavoidable in our current paradigms of care. While medical comorbidities are contributory, a large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions but by confounding issues of substance abuse or homelessness. Identification of the highest risk cohort for readmission can allow more targeted intervention for similar populations with socially challenged patients.