Surgery · 2018
Risk factors for 30-day readmission after adrenalectomy.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Beck Anna C, Goffredo Paolo, Hassan Imran, Sugg Sonia L, Lal Geeta, Howe James R, Weigel Ronald J
Аннотация
BACKGROUND: Readmissions represent a substantial burden to the health care system. Risk factors for 30-day readmission after adrenalectomy were examined.
METHODS: Patients who underwent adrenalectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2015.
RESULTS: Among 4,221 patients who underwent adrenalectomy, 216 (5.1%) were readmitted. On multivariate analysis, pre-operative predictive factors associated with readmission were American Society of Anesthesiologists classification (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.8), disseminated cancer (OR 1.6, CI 1.1-2.5), and adrenal injury (OR 10.9, CI 1.8-68.9). Elective procedures had fewer readmissions (OR 0.50, CI 0.33-0.76). and procedures with greater relative value units had greater readmission rates (OR 1.01, CI 1.004-1.02). An open adrenalectomy (21% of patients) had a higher rate of readmission than a laparoscopic approach (8.0% vs 4.3%, OR 1.5, CI 1.1-2.0). Postoperative risk factors affecting readmission included reoperations (OR 3.2, CI 1.3-8.0), wound complications (OR 6.6, CI 3.8-11.7), systemic infection (OR 6.5, CI 3.9-10.7), renal complications (OR 7.1, CI 2.6-19.2), venous thrombotic events (OR 11.3, CI 5.6-22.6), and discharge to home (OR 0.40, CI 0.22-0.73).
CONCLUSION: Encouraging the appropriate use of laparoscopic adrenalectomy, preventing venous thrombotic events and surgical infections, and improving early post-operative follow-up in high-risk patients may decrease readmissions.
METHODS: Patients who underwent adrenalectomy were selected from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2015.
RESULTS: Among 4,221 patients who underwent adrenalectomy, 216 (5.1%) were readmitted. On multivariate analysis, pre-operative predictive factors associated with readmission were American Society of Anesthesiologists classification (odds ratio [OR] 1.4, confidence interval [CI] 1.1-1.8), disseminated cancer (OR 1.6, CI 1.1-2.5), and adrenal injury (OR 10.9, CI 1.8-68.9). Elective procedures had fewer readmissions (OR 0.50, CI 0.33-0.76). and procedures with greater relative value units had greater readmission rates (OR 1.01, CI 1.004-1.02). An open adrenalectomy (21% of patients) had a higher rate of readmission than a laparoscopic approach (8.0% vs 4.3%, OR 1.5, CI 1.1-2.0). Postoperative risk factors affecting readmission included reoperations (OR 3.2, CI 1.3-8.0), wound complications (OR 6.6, CI 3.8-11.7), systemic infection (OR 6.5, CI 3.9-10.7), renal complications (OR 7.1, CI 2.6-19.2), venous thrombotic events (OR 11.3, CI 5.6-22.6), and discharge to home (OR 0.40, CI 0.22-0.73).
CONCLUSION: Encouraging the appropriate use of laparoscopic adrenalectomy, preventing venous thrombotic events and surgical infections, and improving early post-operative follow-up in high-risk patients may decrease readmissions.