Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation.
Drivers and Risk Factors of Unplanned 30-Day Readmission Following Spinal Cord Stimulator Implantation.
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DOI：
10.1111/ner.12689
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Lad SP
中科院分区：
文献类型：
--
作者：
Elsamadicy AA;Sergesketter A;Ren X;Mohammed Qasim Hussaini S;Laarakker A;Rahimpour S;Ejikeme T;Yang S;Pagadala P;Parente B;Xie J;Lad SP
计划外的30天再入院率大大增加了国家医疗保健支出。脊髓刺激器（SCS）植入后意外30天再入院的驱动因素相对未知。本研究的目的是确定SCS植入后30天意外再入院的驱动因素。查询国家再入院数据库（NRD）以确定2013日历年所有接受SCS植入的患者。患者按再入院状态、“无再入院”和“计划外30天再入院”分组。收集每位患者的患者人口统计资料和合并症。研究的主要结果是意外30天再入院率和相关驱动因素。多变量分析用于确定SCS植入后30天意外再入院的独立预测因素。我们确定了1,521例接受SCS植入的患者，其中113例（7.4%）在30天内经历了计划外的再入院。基线患者人口统计、合并症和医院特征在两个队列之间相似。SCS植入后30天再入院的3个主要驱动因素包括：[1]感染（与SCS装置无关）、[2]装置感染（仅限于硬件感染）和[3]SCS装置机械并发症。此外，肥胖被发现是30天再入院的独立预测因子（OR: 1.86, p=0.008）。我们的研究表明，感染性和机械性并发症是SCS植入后30天意外再入院的主要驱动因素，肥胖是意外再入院的独立预测因素。鉴于SCS的技术进步，有必要进行反复研究，以确定与SCS植入后30天意外再入院率相关的因素，以改善患者预后并降低相关成本。
Unplanned 30-day readmission rates contribute significantly to growing national healthcare expenditures. Drivers of unplanned 30-day readmission after spinal cord stimulator (SCS) implantation are relatively unknown. The aim of this study was to determine drivers of 30-day unplanned readmission following SCS implantation. The National Readmission Database (NRD) was queried to identify all patients who underwent SCS implantation for the 2013 calendar year. Patients were grouped by readmission status,“No Readmission” and “Unplanned 30-day Readmission.” Patient demographics and comorbidities were collected for each patient. The primary outcome of interest was the rate of unplanned 30-day readmissions and associated driving factors. A multivariate analysis was used to determine independent predictors of unplanned 30-day readmission after SCS implantation. We identified 1,521 patients who underwent SCS implantation, with 113 (7.4%) experiencing an unplanned readmission within 30 days. Baseline patient demographics, comorbidities and hospital characteristics were similar between both cohorts. The 3 main drivers for 30-day readmission after SCS implantation include: [1] infection (not related to SCS device), [2] infection due to device (limited to only hardware infection), and [3] mechanical complication of SCS device. Furthermore, obesity was found to be an independent predictor of 30-day readmission (OR: 1.86, p=0.008). Our study suggests that infectious and mechanical complications are the primary drivers of unplanned 30-day readmission after SCS implantation, with obesity as an independent predictor of unplanned readmission. Given the technological advancements in SCS, repeated studies are necessary to identify factors associated with unplanned 30-day readmission rates after SCS implantation to improve patient outcomes and reduce associated costs.
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