Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals
Hospital stay amongst patients undergoing major elective colorectal surgery: predicting prolonged stay and readmissions in NHS hospitals
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DOI：
10.1111/j.1463-1318.2010.02277.x
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发表时间：
2011-07-01
影响因子：
3.4
通讯作者：
Aylin, P.
中科院分区：
文献类型：
--
作者：
Faiz, O.;Haji, A.;Aylin, P.
目的缩短住院时间为患者和医疗保健提供者带来临床和经济效益。本文探讨了住院时间和随之而来的病床资源使用的病人进行择期切除结直肠癌手术在英语NHS trusts.MethodAll患者进行择期结直肠癌切除术之间的恶性肿瘤1996年和2006年在英语NHS信托包括从医院发作统计数据集。进行单因素和多因素分析，以确定独立的预测因素，延长住院时间和28天recommission.ResultsOver 10年期间，186 013例患者进行了择期结直肠手术，在181 NHS信托。约289.3万个床位日用于择期结直肠手术。结肠手术后的住院时间短于直肠手术后（中位数11 vs 13天，P < 0.001）。在10年期间，观察到结肠和直肠手术的中位住院时间减少了2天。直肠切除术后28天内的再入院率高于结肠手术（9.4%比7.6%，P < 0.001）。多因素Logistic回归分析显示，以下独立的预测因素延长住院时间：远端（与近端）肠切除术，良性病变，开放技术，增加年龄，合并症，社会剥夺和低供应商量的状态。28天再入院的独立预测因素包括远端肠切除术，良性诊断，年轻的年龄，社会剥夺和高供应商量status.ConclusionPatients的高龄，相关的合并症，和那些生活在社会剥夺的地区是在增加风险的长期逗留。有针对性的提前出院计划和加强腹腔镜手术的使用可以提高床位资源利用率。
AimReduced hospital stay confers clinical and economic benefits for patients and healthcare providers. This article examines the length of stay and consequent bed resource usage of patients undergoing elective excisional colorectal surgery in English NHS trusts.MethodAll patients undergoing elective colorectal resections for malignancy between 1996 and 2006 in English NHS trusts were included from the Hospital Episode Statistics data set. Unifactorial and multifactorial analyses were performed to identify independent predictors of prolonged stay and 28-day readmission.ResultsOver the 10-year period, 186 013 patients underwent elective colorectal procedures in 181 NHS trusts. About 2.893 million bed days were utilized for elective colorectal surgery. Admission stay was shorter following colonic surgery than following rectal surgery (median 11 vs 13 days, P < 0.001). A 2-day decrease in median stay was observed over the 10-year period for both colonic and rectal procedures. Readmissions within 28 days of discharge were higher following rectal excision than following colonic surgery (9.4 vs 7.6%, P < 0.001). Multiple logistic regression analyses revealed the following independent predictors of prolonged hospital stay: distal (vs proximal) bowel resection, benign pathology, open technique, increasing age, comorbidity, social deprivation and low provider volume status. Independent predictors of 28-day readmission included distal bowel resection, benign diagnosis, young age, social deprivation and high provider volume status.ConclusionPatients of advanced age, with associated comorbidities, and those living in areas of social deprivation are at increased risk of prolonged stay. Targeted pre-emptive discharge planning and enhanced use of laparoscopic surgery could improve bed resource utilization.