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題 名 | The Risk Factors Associated with 30-day Readmission after Colorectal Surgery: A Single-institute Analysis=大腸直腸癌後30天內再住院率之原因分析 |
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作 者 | 劉郁軒; 范仲維; 曾文科; 游彥麟; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 30:3 2019.09[民108.09] |
頁 次 | 頁104-110 |
分類號 | 416.245 |
關鍵詞 | 30日再住院率; 大腸直腸手術; 術前及術後因子; 30-day readmission; Colorectal surgery; Preoperative factors; Postoperative factors; |
語 文 | 英文(English) |
中文摘要 | 目的:臨床上病患重返率常被視為醫療照護品質指標。非預期內的再住院可能會造成醫療資源上的負擔、病患預後及術後恢復品質的下降。這篇研究旨在分析造成大腸直腸癌術後出院的30日內再住院之原因。方法:研究收錄了從2013年1月至2015年12月共440位初診斷為大腸直腸癌並接受根治性或姑息性手術切除的病患,首次住院期間合併其他術式如肝切除或膀胱切除、30日內再住院化療病患等則排除不收案。此篇研究採用回顧性病歷收集病患資料、術式及造成再住院之原因。χ^2 test使用於比較類別變數、Student t test則用於連續變數。顯著意義之變因再使用單變量及多變量分析來找出造成再住院之原因。結果:在比較收案條件後,共340位病患符合條件。其中35位為接受大腸直腸癌術後出院30日內再住院之病患。於單變量分析中,多重合併症、較高的ASA分數、低白蛋白指數、中風病史及首次住院術後發生重大併發症為危險因子;然而,在多變量分析中,造成收案族群30日內再住院之唯一獨立危險因子為首次住院有無發生術後重大合併症。結論:雖然病患本身相關因子並未對再住院率有直接顯著影響,但可以從這篇研究中瞭解到術後發生併發症為獨立危險因子,因此可讓我們來重新擬定預防30日內再住院率的策略。 |
英文摘要 | Purpose. Unplanned readmission has a negative impact on health insurance costs, patient satisfaction, and clinical outcome. Readmission rates indicate surgical quality and quality of care. This study aimed to identify the risk factors that may affect the 30-day readmission after colorectal surgery. Materials and Methods. This retrospective study included 440 patients who underwent colorectal surgery at Chang Gung Memorial Hospital Keelung Branch between January 2, 2013, and December 21, 2015. Patients who received combined operation such as hepatectomy or cystectomy during the index surgery were excluded. Readmission due to scheduled stage operation were also excluded. The chi-square test (for categorical variables) and Student t test (for continuous variables) were used for the analysis. Logic regression analysis was used for single-variable and multivariable analyses. p values of < 0.05 indicated significance. Results. Of the 440 patients, 340 were included in the analysis after applying the exclusion criteria, of whom 35 (10.2%) were readmitted within 30 days after index admission discharge. Although the comorbidities, high American Society of Anesthesiologist (ASA) classification, lower preoperative albumin level, previous cerebral vascular accident, and index admission with major complications had significant impacts on readmission in the single-variable analysis, only the postoperative major complications had a significant impact on readmission in the multivariate analysis. Conclusions. Although patient-related factors have a less direct influence on readmission within 30 days after index admission discharge, this study may lead us to change the strategies for addressing the readmission rate by focusing on reducing the incidence of avoidable postoperative complications. |
本系統中英文摘要資訊取自各篇刊載內容。