- 作者：David S. ; Morris M.D. ; ; ; david.morris2@uphs.upenn.edu ; Jeff ; Rohrbach M.S.N. ; Mary ; Rogers R.N. ; Latha Mary ; Thanka Sundaram M.B.B.S. ; Seema ; Sonnad Ph.D. ; Jose ; Pascual M.D. ; Ph.D. ; Babak ; Sarani M.D. ; Patrick ; Reilly M.D. ; Carrie ; Sims M.D. ; M.S.
- 关键词：early readmission ; risk factors
- 刊名：Journal of Surgical Research
- 出版年：2011
- 出版时间：October 2011
- 年：2011
- 卷：170
- 期：2
- 页码：297-301
- 全文大小：91 K
Background
Unplanned hospital readmissions increase healthcare costs and patient morbidity. We sought to identify risk factors associated with early readmission in surgical patients.Materials and Methods
All admissions from a mixed surgical unit during 2009 were retrospectively reviewed and unplanned readmissions within 30 d of discharge were identified. Demographic data, length of stay, pre-existing diagnoses, and complications during the index admission were evaluated. T-tests and Fisher exact tests were used to examine the relationship of independent variables with readmission. Univariate and multivariate regression analysis were performed.
Results
A total of 1808 index admissions occurred during the study period. In all, 51 (3 % ) patients were readmitted within 30 d of discharge. The majority of readmissions (53 % ) were for infectious reasons. On univariate analyses, DVT (P = 0.004) and acute renal failure (P = 0.002) were associated with increased risk of readmission. Readmitted patients were also more likely to have public insurance (63 % versus 37 % , P = 0.03) and have a longer stay in the hospital (8 d, range 4?4 d versus 3 d, range 2? d, P = 0.001). Initial admission after trauma evaluation was associated with a decreased risk of readmission (OR 0.374, P = 0.004). Other demographic variables and pre-existing conditions were not associated with increased readmission. On multivariate logistic regression only DVT (P = 0.039) and LOS (P = 0.014) remained significant.
Conclusions
Increased LOS and the development of a DVT are risk factors for early unplanned hospital readmission. Admission following trauma is associated with a decreased risk of readmission, possibly due to proactive multidisciplinary discharge planning and geographically-based nurse practitioner involvement.