Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program
Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program
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DOI：
10.1016/j.jvs.2014.05.050
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发表时间：
2014-11-01
影响因子：
4.3
通讯作者：
Schermerhorn, Marc L.
中科院分区：
文献类型：
--
作者：
Curran, Thomas;Zhang, Jennifer Q.;Schermerhorn, Marc L.
背景资料：术后再入院，最近被确定为平价医疗法案中医院质量的一个标志，与发病率，死亡率和医疗保健费用增加有关，但下肢截肢后再入院（莱亚）的数据有限。我们评估了美国外科医师学会国家手术质量改进计划（NSQIP）中莱亚后再入院和出院后不良事件的风险因素。方法：确定了2011-2012年NSQIP中接受经跖骨（TMA）、膝下（BKA）或膝上截肢（AKA）的所有患者。出院前30天再入院的独立预测因素通过多变量logistic回归确定。再入院指征和再干预，在2012年NSQIP只，也evaluated.Results：我们确定了5732例截肢（TMA，12%; BKA，51%; AKA，37%）。再入院率为18%。出院后死亡率为5%（TMA，2%; BKA，3%; AKA，8%; P <0.001）。总体并发症发生率为43%（住院期间，32%;出院后，11%）。79%的病例因伤口相关并发症或额外截肢而再次手术。再入院的独立预测因素包括长期疗养院居住（比值比[OR]，1.3; 95%置信区间[CI]，1.0-1.7），非择期手术（OR，1.4; 95%CI，1.1-1.7），既往血运重建/截肢（OR，1.4; 95%CI，1.1-1.7）、术前充血性心力衰竭（OR，1.7; 95%CI，1.2-2.4）和术前透析（OR，1.5; 95%CI，1.2-1.9）。断头台截肢术（OR，0.6; 95% CI，0.4-0.9）和非家庭出院（OR，0.7; 95% CI，0.6-1.0）可保护再入院。伤口相关的并发症占49%reincidence.Conclusions：出院后发病率，死亡率和再入院是常见的莱亚后。对高危患者进行更密切的随访，优化医疗合并症，积极管理伤口感染可能在减少再入院和出院后不良事件方面发挥作用。
Background: Postoperative readmission, recently identified as a marker of hospital quality in the Affordable Care Act, is associated with increased morbidity, mortality, and health care costs, yet data on readmission after lower extremity amputation (LEA) are limited. We evaluated risk factors for readmission and postdischarge adverse events after LEA in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).Methods: All patients undergoing transmetatarsal (TMA), below-knee (BKA), or above-knee amputation (AKA) in the 2011-2012 NSQIP were identified. Independent predischarge predictors of 30-day readmission were determined by multivariable logistic regression. Readmission indication and reinterventions, available in the 2012 NSQIP only, were also evaluated.Results: We identified 5732 patients undergoing amputation (TMA, 12%; BKA, 51%; AKA, 37%). Readmission rate was 18%. Postdischarge mortality rate was 5% (TMA, 2%; BKA, 3%; AKA, 8%; P < .001). Overall complication rate was 43% (in-hospital, 32%; postdischarge, 11%). Reoperation was for wound-related complication or additional amputation in 79% of cases. Independent predictors of readmission included chronic nursing home residence (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7), nonelective surgery (OR, 1.4; 95% CI, 1.1-1.7), prior revascularization/amputation (OR, 1.4; 95% CI, 1.1-1.7), preoperative congestive heart failure (OR, 1.7; 95% CI, 1.2-2.4), and preoperative dialysis (OR, 1.5; 95% CI, 1.2-1.9). Guillotine amputation (OR, 0.6; 95% CI, 0.4-0.9) and non-home discharge (OR, 0.7; 95% CI, 0.6-1.0) were protective of readmission. Wound-related complications accounted for 49% of readmissions.Conclusions: Postdischarge morbidity, mortality, and readmission are common after LEA. Closer follow-up of high-risk patients, optimization of medical comorbidities, and aggressive management of wound infection may play a role in decreasing readmission and postdischarge adverse events.