High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?
High Rates of Readmission in Necrotizing Pancreatitis: Natural History or Opportunity for Improvement?
复制标题
DOI：
10.1007/s11605-018-04097-6
复制
发表时间：
2019-09-01
影响因子：
3.2
通讯作者：
Zyromski, Nicholas J.
中科院分区：
文献类型：
--
作者：
Maatman, Thomas K.;Mahajan, Sarakshi;Zyromski, Nicholas J.
研究背景坏死性胰腺炎(NP)是一种复杂多种多样的疾病，病程较长。住院再入院是非常常见的；然而，关于NP再入院原因的数据很少。方法对2005-2017年间收治的NP患者进行回顾性分析，确定再次入院的患者。对所有计划外再次住院的患者进行评估，以确定再次住院的原因。记录所有患者的临床和人口学因素。采用两个独立的组间t检验和皮尔逊相关或Fisher精确检验，分析指标入院临床因素与再入院的关系。T；0.05的P值被认为具有统计学意义。结果共纳入601例NP患者。中位年龄52岁(13-96岁)。中位指数入院时间为19天(2-176天)。最常见的病因是胆汁(49.9%)，其次是酒精(20.0%)。432名患者(72%)发生计划外再入院，共971次再次入院(平均每名患者再入院2.3次)。最常见的再入院指征是需要支持性护理和/或干预的症状性坏死(31.2%)，需要抗生素和/或干预的感染性坏死(26.6%)，无法生长(9.7%)，以及非坏死性感染(6.6%)。需要再次入院的患者的指数入院肾功能衰竭(21.3%比14.2%，p=0.05)和心血管衰竭(12.5%比4.7%，p=0.01)的发生率增加。讨论在NP中重新入院是非常常见的。很大一部分重新入院是疾病自然病史的结果；然而，有一定比例的重新入院似乎是可以预防的。器官衰竭患者意外再入院的风险增加，并将从密切随访中受益。
Background Necrotizing pancreatitis (NP) is a complex and heterogeneous disease with a protracted disease course. Hospital readmission is extremely common; however, few data exist regarding the cause of readmission in NP. Methods A retrospective review of NP patients treated between 2005 and 2017 identified patients readmitted both locally and to our hospital. All patients with unplanned hospital readmissions were evaluated to determine the cause for readmission. Clinical and demographic factors of all patients were recorded. As appropriate, two independent group t tests and Pearson's correlation or Fisher's exact tests were performed to analyze the relationship between index admission clinical factors and readmission. p values of < 0.05 were accepted as statistically significant. Results Six hundred one NP patients were reviewed. Median age was 52 years (13-96). Median index admission length of stay was 19 days (2-176). The most common etiology was biliary (49.9%) followed by alcohol (20.0%). Unplanned readmission occurred in 432 patients (72%) accounting for a total of 971 unique readmissions (mean readmissions/patient, 2.3). The most common readmission indications were symptomatic necrosis requiring supportive care and/or intervention (31.2%), infected necrosis requiring antibiotics and/or intervention (26.6%), failure to thrive (9.7%), and non-necrosis infection (6.6%). Patients requiring readmission had increased incidence of index admission renal failure (21.3% vs. 14.2%, p = 0.05) and cardiovascular failure (12.5% vs. 4.7%, p = 0.01). Discussion Readmission in NP is extremely common. Significant portions of readmissions are a result of the disease natural history; however, a percentage of readmissions appear to be preventable. Patients with organ failure are at increased risk for unplanned readmission and will benefit from close follow-up.