Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions.
Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions.
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DOI：
10.1186/1472-6963-12-77
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发表时间：
2012-03-26
影响因子：
2.8
通讯作者：
Comber H
中科院分区：
文献类型：
--
作者：
Kelly M;Sharp L;Dwane F;Kelleher T;Comber H
结直肠癌手术的发展对住院时间（LOS）和再次入院的影响尚未得到很好的描述。在一项基于人群的分析中，我们研究了初次手术后 LOS 和紧急再入院的预测因素。 2002-2008 年诊断的结直肠癌事件（ICD-O2：C18-C20）是从爱尔兰国家癌症登记处确定的，并与医院住院患者的发作有关。对于接受结直肠切除术的患者，确定了相关的医院事件。使用逻辑回归研究了分别预测选择性入院和紧急入院较长 LOS（上四分位数，> 24 天）的因素，以及 LOS 是否预测出院 28 天内紧急再入院。 8197 名患者接受了切除术，其中 63% (n = 5133) 为择期手术，37% (n = 3063) 为急诊入院。择期入院的中位 LOS 为 14 天（四分位数范围 (IQR) = 11-20），紧急入院的中位 LOS 为 21 天（15-33）。无论是急诊入院还是择期入院，年龄较大、有合并症且未婚的患者住院时间较长的可能性显着更高；对于私人病人则减少了。对于急诊患者来说，只有在人流量较大的医院收治的患者中，较长 LOS 的可能性较低。较长的 LOS 与紧急再入院的风险增加相关。四分之一的患者在结直肠切除术后住院至少 25 天。超过三分之一的切除患者是紧急入院的，这些患者的中位 LOS 明显较长。患者和医疗服务相关因素与长期 LOS 相关。较长的 LOS 与紧急再入院的风险增加相关。这些发现的成本影响是巨大的。
The impact of developments in colorectal cancer surgery on length-of-stay (LOS) and re-admission have not been well described. In a population-based analysis, we investigated predictors of LOS and emergency readmission after the initial surgery episode. Incident colorectal cancers (ICD-O2: C18-C20), diagnosed 2002-2008, were identified from the National Cancer Registry Ireland, and linked to hospital in-patient episodes. For those who underwent colorectal resection, the associated hospital episode was identified. Factors predicting longer LOS (upper-quartile, > 24 days) for elective and emergency admissions separately, and whether LOS predicted emergency readmission within 28 days of discharge, were investigated using logistic regression. 8197 patients underwent resection, 63% (n = 5133) elective and 37% (n = 3063) emergency admissions. Median LOS was 14 days (inter-quartile range (IQR) = 11-20) for elective and 21 (15-33) for emergency admissions. For both emergency and elective admissions, likelihood of longer LOS was significantly higher in patients who were older, had co-morbidities and were unmarried; it was reduced for private patients. For emergency patients only the likelihood of longer LOS was lower for patients admitted to higher-volume hospitals. Longer LOS was associated with increased risk of emergency readmission. One quarter of patients stay in hospital for at least 25 days following colorectal resection. Over one third of resected patients are emergency admissions and these have a significantly longer median LOS. Patient- and health service-related factors were associated with prolonged LOS. Longer LOS was associated with increased risk of emergency readmission. The cost implications of these findings are significant.
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DOI：
10.1136/qshc.5.3.172
发表时间：
1996-09-01
期刊：
QUALITY IN HEALTH CARE
影响因子：
--
作者：
Clarke, A
通讯作者：
Clarke, A
影响因子：
3.4
作者：
Faiz, O.;Haji, A.;Aylin, P.
通讯作者：
Aylin, P.
影响因子：
7.2
作者：
Grocott, M. P. W.;Browne, J. P.;Mythen, M. G.
通讯作者：
Mythen, M. G.
影响因子：
3.9
作者：
Guinier, D.;Mantion, G. A.;Panis, Y.
通讯作者：
Panis, Y.
影响因子：
3.4
作者：
Akhtar, S.;Sinha, S.;Burke, D.
通讯作者：
Burke, D.