Risk scoring can predict readmission after endocrine surgery
Risk scoring can predict readmission after endocrine surgery
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DOI：
10.1016/j.surg.2014.08.023
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发表时间：
2014-12-01
期刊：
影响因子：
3.8
通讯作者：
Moalem, Jacob
中科院分区：
文献类型：
--
作者：
Iannuzzi, James C.;Fleming, Fergal J.;Moalem, Jacob
背景医院和外科医生同时面临着减少再入院和住院时间的压力。我们假设内分泌手术后的再入院可以通过使用一种新的风险评分来预测。在国家外科质量改进计划数据库中查询2011年和2012年期间进行的宫颈内分泌手术。主要终点是30天内计划外再入院。多变量逻辑回归用于建立和验证一个评分系统，以预测计划外再入院。总体而言，纳入了34，046例病例，再入院率为2.8%（n = 947）。最常见的再入院原因为低钙血症（32.4%）、手术部位感染（8.4%）和血肿（8.0%）（仅2012年数据）。使用以下因素创建再入院风险评分：甲状腺恶性肿瘤、低白蛋白血症、肾功能不全、美国麻醉医师协会分级和住院时间>1天。根据风险因素数量预测的再入院率为：0个风险因素1.7%，1个风险因素（5-11分）3.2%，2个风险因素5.8%，3个风险因素10.5%，4个风险因素18.0%。模型具有较好的预测能力，c = 0.646。子宫颈内分泌手术后的再入院是可以预测的。该风险评分可用于指导术前、住院和门诊护理的资源使用，以减少再入院。
Background. Hospitals and surgeons simultaneously are pressured to decrease readmissions and duration of stay. We hypothesized that readmissions after endocrine surgery could be predicted by using a novel risk-score.Methods. The National Surgical Quality Improvement Program database was queried for cervical endocrine operations performed during 2011 and 2012. The primary end point was unplanned readmission within 30 days. Multivariable logistic regression was used to create and validate a scoring system to predict unplanned readmissions.Results. Overall, 34,046 cases were included with a readmission rate of 2.8% (n = 947). The most frequent reasons for readmission were hypocalcemia (32.4%) surgical-site infection (8.4%), and hematoma (8.0%) (2012 data only). The readmission risk score was created using the following factors: thyroid malignancy, hypoalbuminemia, renal insufficiency, American Society of Anesthesiologists class, and duration of stay >1 day. Predicted readmission rate by number of risk factors was 1.7 % for 0 risk factors, 3.2% for 1 risk factor (5-11 points), 5.8% for 2 risk factors, 10.5% for 3 risk factors, and 18.0% for 4 risk factors. The model had good predictive ability with c = 0.646.Conclusion. Readmissions after cervical endocrine operations can be predicted. This risk score could be used to direct resource use for preoperative, inpatient, and outpatient care delivery to reduce readmissions.