Readmission After Ileostomy Creation Retrospective Review of a Common and Significant Event
Readmission After Ileostomy Creation Retrospective Review of a Common and Significant Event
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DOI：
10.1097/sla.0000000000001683
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发表时间：
2017-02-01
影响因子：
9
通讯作者：
Temple, Larissa K.
中科院分区：
文献类型：
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作者：
Fish, Daniel R.;Mancuso, Carol A.;Temple, Larissa K.
目的：探讨新造回造口术后再入院的原因及预测因素。背景：据报道，与其他手术患者相比，新回肠造口患者的再入院率更高，但预测因素的数据有限。方法：回顾性分析2家相关医院1114例首次行回肠造口术的成人病例。主要终点是手术后60天内的再入院。采用多元逻辑回归识别独立预测因子；在二次分析中，使用接受者-操作者特征曲线下面积（AUC）来评估年龄分层模型。结果：407例患者接受了新的回肠造口术；58%患有癌症，31%患有IBD；49%行LAR， 27%行结肠切除术，14%行直结肠切除术。中位住院时间为8天。其中39%的患者在出院后中位12天返回医院，28%的患者再次入院（n = 113）。再入院最常见的原因是脱水（42%）、腹腔内感染（33%）和腹腔外感染（29%）。脱水与较晚、较长时间和反复再入院有关。再入院的独立显著预测因素为Clavien-Dindo并发症3 - 4级[比值比（OR） 6.7]、Charlson合并症指数（OR 1.4 /分）和环状造口（OR 2.2）；较长的住院时间（OR 0.5）和65岁及以上（OR 0.4）具有保护作用。65岁以上或以下的队列分层显示，老年患者再入院更可预测（AUC 0.84），可预防的原因更多，而年轻患者再入院难以预测或预防（AUC 0.65）。结论：再入院最常见的原因是脱水，并可通过严重并发症、合并症负担、环形造口、住院时间较短和年龄预测。老年患者的再入院更容易预测，这是一个重要的改善目标。
Objective: To evaluate causes and predictors of readmission after new ileostomy creation.Background: New ileostomates have been reported to have higher readmission rates compared with other surgical patients, but data on predictors are limited.Methods: A total of 1114 records at 2 associated hospitals were reviewed to identify adults undergoing their first ileostomy. Primary outcome was readmission within 60 days of surgery. Multiple logistic regression was used to identify independent predictors; area under the receiver-operator characteristic curves (AUC) were used to evaluate age-stratified models in secondary analysis.Results: In all, 407 patients underwent new ileostomy; 58% had cancer, 31% IBD; 49% underwent LAR, 27% colectomy, and 14% proctocolectomy. Median length of stay was 8 days. Among the patients, 39% returned to hospital, and 28% were readmitted (n = 113) at a median of 12 days postdischarge. The most common causes of readmission were dehydration (42%), intraperitoneal infections (33%), and extraperitoneal infections (29%). Dehydration was associated with later, longer, and repeated readmission. Independent significant predictors of readmission were Clavien-Dindo complication grade 3 to 4 [odds ratio (OR) 6.7], Charlson comorbidity index (OR 1.4 per point), and loop stoma (OR 2.2); longer length of stay (OR 0.5) and age 65 years or older (OR 0.4) were protective. Cohort stratification above or below age 65 revealed that older patient readmissions were more predictable (AUC 0.84) with more preventable causes, whereas younger patient readmissions were difficult to predict or prevent (AUC 0.65).Conclusions: Readmissions are most commonly caused by dehydration, and are predicted by serious complications, comorbidity burden, loop stoma, shorter length of stay, and age. Readmissions in older patients are easier to predict, representing an important target for improvement.