Clinical characteristics associated with readmission among patients undergoing vascular surgery.
Clinical characteristics associated with readmission among patients undergoing vascular surgery.
复制标题
接受血管手术的患者与再入院相关的临床特征。
DOI：
10.1016/j.jvs.2013.10.103
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发表时间：
2014
影响因子：
4.3
通讯作者：
Matsumura,Jon
中科院分区：
文献类型：
--
作者：
Engelbert,TravisL;Fernandes-Taylor,Sara;Gupta,PrateekK;Kent,KCraig;Matsumura,Jon
血管手术干预后再次入院是频繁的，昂贵的，通常被认为是可以预防的。由于再入院率高，血管手术的结果最近受到医疗保险的审查。我们确定患者和临床特征与再入院的血管surgery patients.MethodsFrom 2009年至2013年，所有患者（n = 2505）的医疗记录进行了回顾性分析，在一个单一的三级医疗机构的血管外科服务的干预。社会人口学和临床特征进行了检查与30天再入院同一institution.ResultsThe 30天再入院率相同的机构为9.7%（n = 244）。最可能导致再入院的手术是膝下（25%）、足部（22%）和脚趾截肢（19%）以及下肢血运重建（22%）。医疗补助（16.8%）和医疗保险（10.0%）覆盖的患者最有可能再次入院，其次是收费服务（9.5%），自费（8.0%）和健康维护组织（5.5%;P<0.05）。紧急入院的患者再入院的可能性（16.2%）高于择期入院的患者（9.1%;P<0.01）。使用All Patient Refined Diagnosis Related Groups软件（3 M Health Information Systems，Wallingford，Conn）评定的患者严重程度预测再入院（16.2%高严重程度vs 6.2%低严重程度;P<0.01）。再次入院患者的初始住院时间长于未再次入院患者（分别为8.5天和6.1天;P<0.01）。在单变量分析中，首次住院期间入住重症监护室与较高的再入院率相关（入住重症监护室的18.3% vs未入住重症监护室的9.5%;P<0.05）。出院目的地也是再入院的强预测因素（康复，19.2%;专业护理机构，16.2%;家庭，6.2%;P<0.01）。紧急入院，接近医院，住院时间，下肢开放手术或截肢，出院目的地的影响坚持在多变量Logistic回归（P<0.05）。应将工作重点放在接受选定干预措施（截肢、下肢血运重建）的亚组、紧急入院的亚组和住院时间延长的亚组。出院时需要急性期后护理的患者特别容易再入院，需要特别注意出院计划和出院后护理的协调。通过关注有再入院风险的亚组，可以有效地确定预防资源的目标。
ObjectiveReadmission after a vascular surgery intervention is frequent, costly, and often considered preventable. Vascular surgery outcomes have recently been scrutinized by Medicare because of the high rates of readmission. We determined patient and clinical characteristics associated with readmission in a cohort of vascular surgery patients.MethodsFrom 2009 to 2013, the medical records of all patients (n = 2505) undergoing interventions by the vascular surgery service at a single tertiary care institution were retrospectively reviewed. Sociodemographic and clinical characteristics were examined for association with 30-day readmission to the same institution.ResultsThe 30-day readmission rate to the same institution was 9.7 % (n = 244). Procedures most likely to result in readmission were below-knee (25%), foot (22%), and toe amputations (19%), as well as lower extremity revascularization (22%). Patients covered by Medicaid (16.8%) and Medicare (10.0%) were most likely to be readmitted, followed by fee-for-service (9.5%), self-pay (8.0%), and health maintenance organizations (5.5%;P< .05). Patients urgently admitted were more likely to be readmitted (16.2%) than those electively admitted (9.1%;P< .01). Patient severity as rated using the All Patient Refined Diagnosis Related Groups software (3M Health Information Systems, Wallingford, Conn) predicted readmission (16.2% high vs 6.2% low severity;P< .01). Initial length of stay was longer for readmitted than nonreadmitted patients (8.5 vs 6.1 days, respectively;P< .01). Intensive care unit admission during the initial hospitalization was associated with higher readmission rates in univariable analysis (18.3% with vs 9.5% without intensive care unit stay;P< .05). Discharge destination was also a strong predictor of readmission (rehabilitation, 19.2%; skilled nursing facility, 16.2%; home, 6.2%;P< .01). The effects of urgent admission, proximity to hospital, length of stay, lower extremity open procedure or amputation, and discharge destination persisted in multivariable logistic regression (P< .05).ConclusionsTo reduce readmission rates effectively, institutions must identify high-risk patients. Efforts should focus on subgroups undergoing selected interventions (amputations, lower extremity revascularization), those with urgent admissions, and patients with extended hospital stays. Patients in need of postacute care upon discharge are especially prone to readmission, requiring special attention to discharge planning and coordination of postdischarge care. By focusing on subgroups at risk for readmission, preventative resources can be efficiently targeted.