Early hospital readmission after bariatric surgery
Early hospital readmission after bariatric surgery
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DOI：
10.1007/s00464-015-4483-4
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发表时间：
2016-06-01
影响因子：
3.1
通讯作者：
Lidor, Anne O.
中科院分区：
文献类型：
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作者：
Aman, Mustafa W.;Stem, Miloslawa;Lidor, Anne O.
随着全国范围内减肥手术的增加以及对质量和结局指标的日益关注，降低早期再入院率（EHR）引起了极大的临床兴趣。方法采用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据集（2012-2013），对2012-2013年接受减肥手术的肥胖症患者和体重指数≥ 35的患者进行研究。EHR定义为减肥手术后30天内至少有一次住院。再入院与患者因素之间的关联采用多变量logistic回归分析进行评估。此外，原因再入院searched.Results共确定了36,042例患者。总体EHR发生率为4.70%[腹腔镜（腹腔镜）可调节带1.87%，腹腔镜胃旁路术（GBP）5.94%，开放性GBP 7.86%，袖状胃切除术3.73%]，发生于术后中位11天。2012年至2013年，EHR率显著下降（5.15 vs. 4.32%，p < 0.001）。中位年龄和BMI分别为44岁和44. 7 kg/m（2），78. 99%为女性，70. 78%为白色。最常见的再入院原因是恶心/呕吐（12.95%），其次是腹痛（11.75%）和脱水（10.54%）。在多变量分析中，与再入院最密切相关的因素是手术类型（腹腔镜组：对照组;开放性GBP：OR 3.78，95% CI 2.47-5.80;腹腔镜组GBP 3.18，2.39-4.22;袖状胃切除术：2.03，1.52-2.71;所有p < 0.001），使用类固醇（1.82，1.33-2.48，p < 0.001），出院前并发症（1.64，1.20-2.24，p < 0.001），黑人（1.51，1.34-1.71，p < 0.001）。结论肥胖治疗中心应考虑实施标准化的门诊监测方案，对确定为早期再入院高危患者进行监测，这反过来又会降低总体成本并提高护理质量。
Background With the rise in bariatric procedures being performed nationwide and the growing focus on quality and outcome measures, reducing early hospital readmission (EHR) rates has garnered great clinical interest. The aim of this study was to identify the incidence, reasons, and risk factors for EHR after bariatric surgery.Methods Using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset (2012-2013), patients with a diagnosis of obesity and body mass index >= 35 who underwent bariatric surgery were identified. EHR was defined as at least one hospitalization within 30 days of bariatric procedure. The association between readmission and patient factors was assessed using multivariable logistic regression analysis. In addition, reasons for readmission were sought.Results A total of 36,042 patients were identified. The overall EHR rate was 4.70 % [ laparoscopic (lap) adjustable band 1.87 %, lap gastric bypass (GBP) 5.94 %, open GBP 7.86 %, and sleeve gastrectomy 3.73 %], and it occurred at the median of 11 days postoperatively. The rate of EHR significantly decreased from 2012 to 2013 (5.15 vs. 4.32 %, p < 0.001). The median age and BMI were 44 years and 44.7 kg/m(2), respectively, 78.99 % were female, and 70.78 % were white. The most common reason for readmission was nausea/vomiting (12.95 %), followed by abdominal pain (11.75 %) and dehydration (10.54 %). On multivariable analysis, factors most strongly associated with readmission were procedure type (lap band: reference; open GBP: OR 3.78, 95 % CI 2.47-5.80; lap GBP 3.18, 2.39-4.22; sleeve gastrectomy: 2.03, 1.52-2.71; all p < 0.001), steroid use (1.82, 1.33-2.48, p < 0.001), predischarge complication (1.64, 1.20-2.24, p < 0.001), and black population (1.51, 1.34-1.71, p < 0.001).Conclusions Bariatric centers should consider implementing standardized protocols for outpatient monitoring of patients identified to be at high risk of experiencing early readmission, which in turn would decrease overall costs and improve quality of care.