Risk factors for 30-day unplanned readmission following infrainguinal endovascular interventions
Risk factors for 30-day unplanned readmission following infrainguinal endovascular interventions
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DOI：
10.1016/j.jvs.2016.08.093
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发表时间：
2017-02-01
影响因子：
4.3
通讯作者：
Schermerhorn, Marc L.
中科院分区：
文献类型：
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作者：
Bodewes, Thomas C. F.;Soden, Peter A.;Schermerhorn, Marc L.
目标：手术干预后的计划外再入院与不良事件相关，并导致医疗保健费用增加。尽管许多研究定义了下肢旁路手术后的风险因素，但血管内介入术后再入院的证据有限。本研究旨在确定30天计划外再入院的预测因素后，腹股沟下血管内interventions.Methods：我们确定了所有患者接受腹股沟下血管内介入治疗的目标血管模块的美国外科医师学会国家外科质量改进计划在2012年和2014年之间。围手术期结局按症状状态分层（慢性肢体威胁性缺血[CLI] vs跛行）。排除了在索引入院期间死亡的患者和30天后仍留在医院的患者。评价了与首次手术相关的计划外再入院的适应症。多变量logistic回归被用来确定术前和在医院（在指数入院）的风险因素30天计划外reincission.Results：有4449例患者接受腹股沟下血管内介入治疗，其中2802（63%）有CLI（66%组织损失）和1647（37%）有跛行。CLI和跛行患者的计划外再入院率分别为16%（n = 447）和6.5%（n = 107）。再次入院患者的死亡率高于未再次入院患者（CLI，3.4% vs 0.7% [P
Objective: Unplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing health care costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aimed to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions.Methods: We identified all patients undergoing an infrainguinal endovascular intervention in the targeted vascular module of the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2014. Perioperative outcomes were stratified by symptom status (chronic limb-threatening ischemia [CLI] vs claudication). Patients who died during index admission and those who remained in the hospital after 30 days were excluded. Indications for unplanned readmission related to the index procedure were evaluated. Multivariable logistic regression was used to identify preoperative and in-hospital (during index admission) risk factors of 30-day unplanned readmission.Results: There were 4449 patients who underwent infrainguinal endovascular intervention, of whom 2802 (63%) had CLI (66% tissue loss) and 1647 (37%) had claudication. The unplanned readmission rates for CLI and claudication patients were 16% (n = 447) and 6.5% (n = 107), respectively. Mortality after index admission was higher for readmitted patients compared with those not readmitted (CLI, 3.4% vs 0.7% [P