Hospital Readmissions after Surgery: How Important Are Hospital and Specialty Factors?
Hospital Readmissions after Surgery: How Important Are Hospital and Specialty Factors?
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DOI：
10.1016/j.jamcollsurg.2016.12.034
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发表时间：
2017-04-01
影响因子：
5.2
通讯作者：
Hawn, Mary T.
中科院分区：
文献类型：
--
作者：
Hollis, Robert H.;Graham, Laura A.;Hawn, Mary T.
背景：手术后再入院率可以代表整体医院效应或专科效应和患者效应的结合。我们假设不同专科的再入院率比同一医院不同专科的再入院率相关性更强。研究设计：对2008 - 2014年退伍军人事务医院的普通、骨科和血管专科，评估6个大容量手术和每个专科的30天风险调整再入院率。使用Pearson相关系数评估相关性。结果：84家医院共进行了64,724例骨科手术、24,963例普通外科手术和10,399例血管住院手术；平均再入院率分别为6.3%、13.6%和16.4%。专科调整后的医院再入院率：普通外科和骨科（r = 0.21; p = 0.06）、普通外科和血管外科（r = 0.15; p = 0.19）、血管外科和骨科（r = 0.07; p = 0.55）之间没有相关性。在专科，我们发现膝关节和髋关节置换术再入院率（r = 0.39; p < 0.01）与结肠切除术和腹疝修补术（r = 0.24; p = 0.03）之间存在适度相关性，但下肢搭桥术和血管内主动脉修补术之间没有相关性（r = 0.13; p = 0.26）。总体而言，在控制患者水平因素的情况下，再入院的变化中有1.9%可归因于专科水平因素；只有0.6%可归因于医院层面的因素。结论：骨科、血管外科和普外科的再入院率在专科间无相关性；在这3个专科中，其中2个专科的2种手术之间存在适度的相关性。这些发现表明，医院手术再入院率主要是由患者和手术特定因素造成的，而不是由更广泛的专科和/或医院影响造成的。由爱思唯尔公司代表美国外科医师学会出版。
BACKGROUND: Hospital readmission rates after surgery can represent an overall hospital effect or a combination of specialty and patient effects. We hypothesized that hospital readmission rates for procedures within specialties were more strongly correlated than rates across specialties within the same hospital.STUDY DESIGN: For general, orthopaedic, and vascular specialties at Veterans Affairs hospitals during 2008 to 2014, 30-day risk-adjusted readmission rates were estimated for 6 high-volume procedures and each specialty. Relationships were assessed using the Pearson correlation coefficient.RESULTS: At 84 hospitals, 64,724 orthopaedic, 24,963 general, and 10,399 vascular inpatient procedures were performed; mean readmission rates were 6.3%, 13.6%, and 16.4%, respectively. There was no correlation between specialty-specific adjusted hospital readmission rates: general and orthopaedic (r = 0.21; p = 0.06), general and vascular (r = 0.15; p = 0.19), and vascular and orthopaedic surgery (r = 0.07; p = 0.55). Within specialties, we found modest correlations between knee and hip arthroplasty readmission rates (r = 0.39; p < 0.01) and colectomy and ventral hernia repair (r = 0.24; p = 0.03), but not between lower-extremity bypass and endovascular aortic repair (r = 0.13; p = 0.26). Overall, controlling for patient-level factors, 1.9% of the variation in readmissions was attributable to specialty-level factors; only 0.6% was attributable to hospital-level factors.CONCLUSIONS: Hospital readmission rates for orthopaedic, vascular, and general surgery were not correlated between specialties; within each of the 3 specialties, modest correlations were found between 2 procedures within 2 of these specialties. These findings suggest that hospital surgical readmission rates are primarily explained by patient-and procedure-specific factors and less by broader specialty and/or hospital effects. Published by Elsevier Inc. on behalf of the American College of Surgeons.