JAMA Surg:普外科紧急手术后再住院率和风险因素

2015-11-15 MedSci MedSci原创

普外科紧急手术后再住院是常见现象,根据患者因素和诊断疾病种类不同而变化多样。每5个再住院患者中有一个去了其他医院住院,导致不能连续为患者提供医疗服务,使用再住院率衡量医疗质量的实用性降低。协助社会能力脆弱患者,减少包括感染在内的术后并发症是减少再住院率的靶点所在。

背景:手术后再次住院率越来越多的被用作衡量医疗质量和绩效工资发放标准的一个标志。据研究者所知,EGS (emergency general surgery,紧急普外科手术)术式完成后患者再次回到初始医院或其他医院住院的全面数据目前尚不存在。

研究目标:确定再住院率,识别常见EGS术式后再住院的危险因素。

设计,设定和受试者:2015年1月15日使用加州住院患者数据库(2007-2011)确定接受美国创伤手术协会定义的EGS患者名单。患者年龄在18岁及以上。在11个EGS诊断组,识别了5个常见的EGS术式。收集患者人口学特征(性别、年龄、种族和医疗保险类型)以及Charlson发病率指数评分、住院时间、并发症和出院结局数据。使用多元logistic回归模型分析确定再住院相关因素。

主要结果和测量措施:三十天内再住院。

结果:符合入选标准的患者共有177511例,57.1%是白人,48.8%的患者有个人医疗保险,大多数(51.3%)患者年龄在45岁及以上。腹腔镜阑尾切除术(35.2%)和腹腔镜胆囊切除术(19.3%)是最常见的术式。总体30天再住院率为5.91%。不同术式再住院比例不等,从4.1%(上消化道手术)到16.8%(心胸手术)。再住院患者中16.8%进入到另外一家医院。再住院的预测因素包括Charlson发病率指数评分为2分或更高(调整后的优势比2.26,95%CI2.14-2.39),医生劝告无效(调整后的优势比2.24,95%CI1.89-2.66)和公共保险(调整后优势比为1.55,95%CI1.47-1.64)。再住院的最常见原因是手术部位感染(16.9%)、胃肠道并发症(11.3%)和肺部并发症(3.6%)。

结论和意义:EGS手术后再住院是常见现象,根据患者因素和诊断疾病种类不同而变化多样。每5个再住院患者中有一个去了其他医院住院,导致不能连续为患者提供医疗服务,使用再住院率衡量医疗质量的实用性降低。协助社会能力脆弱患者,减少包括感染在内的术后并发症是减少再住院率的靶点所在。

原始出处:

1.Joaquim M. Havens, Olubode A. Olufajo, Zara R. Cooper, et al. Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery. JAMASurg. Published online November 11,2015. 

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1804407, encodeId=660c180440ec2, content=<a href='/topic/show?id=9a7be70170f' target=_blank style='color:#2F92EE;'>#紧急手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77017, encryptionId=9a7be70170f, topicName=紧急手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Apr 12 01:13:00 CST 2016, time=2016-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663228, encodeId=b59516632285a, content=<a href='/topic/show?id=91a330610e0' target=_blank style='color:#2F92EE;'>#再住院率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30610, encryptionId=91a330610e0, topicName=再住院率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=515025593328, createdName=12498974m59暂无昵称, createdTime=Wed Feb 24 14:13:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48621, encodeId=c0a04862168, content=同意, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:22:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523188, encodeId=263015231881e, content=<a href='/topic/show?id=1a1de7006b0' target=_blank style='color:#2F92EE;'>#紧急#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77006, encryptionId=1a1de7006b0, topicName=紧急)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b88211514540, createdName=guguangxiang, createdTime=Tue Nov 17 12:13:00 CST 2015, time=2015-11-17, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1804407, encodeId=660c180440ec2, content=<a href='/topic/show?id=9a7be70170f' target=_blank style='color:#2F92EE;'>#紧急手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77017, encryptionId=9a7be70170f, topicName=紧急手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Apr 12 01:13:00 CST 2016, time=2016-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663228, encodeId=b59516632285a, content=<a href='/topic/show?id=91a330610e0' target=_blank style='color:#2F92EE;'>#再住院率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30610, encryptionId=91a330610e0, topicName=再住院率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=515025593328, createdName=12498974m59暂无昵称, createdTime=Wed Feb 24 14:13:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48621, encodeId=c0a04862168, content=同意, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:22:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523188, encodeId=263015231881e, content=<a href='/topic/show?id=1a1de7006b0' target=_blank style='color:#2F92EE;'>#紧急#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77006, encryptionId=1a1de7006b0, topicName=紧急)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b88211514540, createdName=guguangxiang, createdTime=Tue Nov 17 12:13:00 CST 2015, time=2015-11-17, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1804407, encodeId=660c180440ec2, content=<a href='/topic/show?id=9a7be70170f' target=_blank style='color:#2F92EE;'>#紧急手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77017, encryptionId=9a7be70170f, topicName=紧急手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Apr 12 01:13:00 CST 2016, time=2016-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663228, encodeId=b59516632285a, content=<a href='/topic/show?id=91a330610e0' target=_blank style='color:#2F92EE;'>#再住院率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30610, encryptionId=91a330610e0, topicName=再住院率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=515025593328, createdName=12498974m59暂无昵称, createdTime=Wed Feb 24 14:13:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48621, encodeId=c0a04862168, content=同意, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:22:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523188, encodeId=263015231881e, content=<a href='/topic/show?id=1a1de7006b0' target=_blank style='color:#2F92EE;'>#紧急#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77006, encryptionId=1a1de7006b0, topicName=紧急)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b88211514540, createdName=guguangxiang, createdTime=Tue Nov 17 12:13:00 CST 2015, time=2015-11-17, status=1, ipAttribution=)]
    2015-12-26 忠诚向上

    同意

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1804407, encodeId=660c180440ec2, content=<a href='/topic/show?id=9a7be70170f' target=_blank style='color:#2F92EE;'>#紧急手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77017, encryptionId=9a7be70170f, topicName=紧急手术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b65161, createdName=yb6560, createdTime=Tue Apr 12 01:13:00 CST 2016, time=2016-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1663228, encodeId=b59516632285a, content=<a href='/topic/show?id=91a330610e0' target=_blank style='color:#2F92EE;'>#再住院率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30610, encryptionId=91a330610e0, topicName=再住院率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=515025593328, createdName=12498974m59暂无昵称, createdTime=Wed Feb 24 14:13:00 CST 2016, time=2016-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=48621, encodeId=c0a04862168, content=同意, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sat Dec 26 19:22:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1523188, encodeId=263015231881e, content=<a href='/topic/show?id=1a1de7006b0' target=_blank style='color:#2F92EE;'>#紧急#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77006, encryptionId=1a1de7006b0, topicName=紧急)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b88211514540, createdName=guguangxiang, createdTime=Tue Nov 17 12:13:00 CST 2015, time=2015-11-17, status=1, ipAttribution=)]