30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State
30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State
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DOI：
10.1016/j.jcin.2011.08.013
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发表时间：
2011-12-01
影响因子：
11.3
通讯作者：
King, Spencer B., III
中科院分区：
文献类型：
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作者：
Hannan, Edward L.;Zhong, Ye;King, Spencer B., III
目的 本研究旨在报告经皮冠状动脉介入治疗 (PCI) 30 天的再入院率，确定分期（计划）再入院对总体再入院率的影响，确定 PCI 后非分期再入院的重要预测因素，并明确再入院的原因。 背景 医院再入院频繁发生并产生大量费用。 PCI 是最常见和最昂贵的手术之一，人们对 PCI 再入院的性质和程度知之甚少。方法我们使用全国最大的全州 PCI 登记处回顾性分析了 PCI 后 30 天的再入院情况，以确定 2007 年 1 月 1 日至 2007 年 11 月 30 日期间接受 PCI 的 40,093 名纽约州患者。考虑了人口统计学变量、手术前危险因素、PCI 并发症和住院时间。作为再入院的潜在预测因素，并使用主要诊断从纽约的管理数据库中确定了再入院的原因。 结果 所有 PCI 患者中共有 15.6% 在 30 天内再入院，其中 20.6% 的再入院进行了分期。在非分期再入院中，最常见的再入院原因是慢性缺血性心脏病（22.5%）、胸痛（10.8%）和心力衰竭（8.2%）。共有 2,015 名患者（占再入院人数的 32.2%）接受了重复 PCI。十三个人口和诊断风险因素以及较长的住院时间都与较高的再入院率相关。 结论 未来减少再入院的努力应侧重于识别风险最高的患者以及他们再入院的原因。分期也应该从成本效益的角度进行检查，作为患者独特风险因素的函数。 （J Am Coll Cardiol Intv 2011；4:1335-42）(C) 2011 年，美国心脏病学会基金会
Objectives This study sought to report percutaneous coronary intervention (PCI) 30-day readmission rates, identify the impact of staged (planned) readmissions on overall readmission rates, determine the significant predictors of unstaged readmissions after PCI, and specify the reasons for readmissions.Background Hospital readmissions occur frequently and incur substantial costs. PCI are among the most common and costly procedures, and little is known about the nature and extent of readmissions for PCI.Methods We retrospectively analyzed 30-day readmissions after PCI using the nation's largest state-wide PCI registry to identify 40,093 New York State patients who underwent PCI between January 1, 2007, and November 30, 2007. Demographic variables, pre-procedural risk factors, complications of PCI, and length of stay were considered as potential predictors of readmission, and reasons for readmission were identified from New York's administrative database using principal diagnoses.Results A total of 15.6% of all PCI patients were readmitted within 30 days, and 20.6% of these readmissions were staged. Among unstaged readmissions, the most common reasons for readmission were chronic ischemic heart disease (22.5%), chest pain (10.8%), and heart failure (8.2%). A total of 2,015 patients (32.2% of readmissions) underwent a repeat PCI. Thirteen demographic and diagnostic risk factors, as well as longer lengths of stay, were all associated with higher readmission rates.Conclusions Future efforts to reduce readmissions should be directed toward the recognition of patients most at risk, and the reasons they are readmitted. Staging also should be examined from a cost-effectiveness standpoint as a function of patients' unique risk factors. (J Am Coll Cardiol Intv 2011;4:1335-42) (C) 2011 by the American College of Cardiology Foundation