心脏手术后再次入院的目的地及其与死亡率结果的关系：一项基于人群的回顾性研究

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2024-09-04 DOI:10.1016/j.lanwpc.2024.101189

Md Shajedur Rahman Shawon , Sanja Lujic , Yashutosh Joshi , Louisa Jorm

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引用次数: 0

摘要

背景目前还不清楚手术前转院与心脏手术患者再入院目的地之间的关系，也不清楚再入院到手术医院以外的医院是否与死亡率升高有关。方法我们分析了澳大利亚新南威尔士州居民的关联医院和死亡记录，这些居民年龄≥18岁，在2003-2022年期间接受冠状动脉旁路移植术（CABG）或主动脉瓣置换术（SAVR）后30天内急诊再入院。在接受心脏手术的 102,540 名患者中（孤立 CABG = 63,000 人，SAVR = 27,482 人，合并 = 12,058 人），28.7%（n = 29,398 人）在手术前转院，而 30 天内再入院率为 14.7%（n = 14,708 人）。在再入院期间，35.7%（3499/9795）没有手术前转院的患者和12.0%（590/4913）有手术前转院的患者返回了手术医院。在再次入院的患者中，再次入院到非指标医院的患者的 30 天死亡率没有显著差异，无论是总体上（调整后的几率比 [aOR] = 1.03 95% CI 0.75-1.41），还是按手术前转院进行的分层分析（未转院：aOR = 1.07，95% CI 0.75-1.52；转院：aOR = 0.88，95% CI 0.45-1.72）。在手术前转院的患者中，再次入住手术医院（参考）、最初入院医院（aOR = 1.00，95% CI 0.50-2.00）或第三家不同医院（aOR = 0.70，95% CI 0.33-1.48）的患者的 30 天死亡率相似。释义尽管许多澳大利亚患者在心脏手术后再次入院时，入院医院与手术医院或最初入院医院不同，但这种再次入院与死亡率增加无关。

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Readmission destination following cardiac surgery and its association with mortality outcomes: a population-based retrospective study

Background

It is unclear how pre-surgery transfer relates to readmission destination among patients undergoing cardiac surgery and whether readmission to a hospital other than the operating hospital is associated with increased mortality.

Methods

We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years who had an emergency readmission within 30 days following coronary artery bypass graft (CABG) or surgical aortic valve replacement (SAVR) in 2003–2022. Mixed-effect multi-level modelling was used to evaluate associations of readmission destination with 30-day mortality, overall and stratified by pre-surgery transfer.

Findings

Of 102,540 patients undergoing cardiac surgery (isolated CABG = 63,000, SAVR = 27,482, combined = 12,058), 28.7% (n = 29,398) had pre-surgery transfer, while the 30-day readmission rate was 14.7% (n = 14,708). During readmission, 35.7% (3499/9795) of those without pre-surgery transfer and 12.0% (590/4913) of those with pre-surgery transfer returned to the operating hospital. Among readmitted patients, 30-day mortality did not differ significantly for those who were readmitted to a non-index hospital, both overall (adjusted odds ratio [aOR] = 1.03 95% CI 0.75–1.41), and in analyses stratified by pre-surgery transfer (no transfer: aOR = 1.07, 95% CI 0.75–1.52; transfer: aOR = 0.88, 95% CI 0.45–1.72). Among patients who had pre-surgery transfer, 30-day mortality was similar among patients who were readmitted to the index operating hospital (reference), the initial admitting hospital (aOR = 1.00, 95% CI 0.50–2.00) or a third, different, hospital (aOR = 0.70, 95% CI 0.33–1.48).

Interpretation

Although many Australian patients who are readmitted following cardiac surgery are readmitted to hospitals different to the operating or initial admitting hospital, such readmissions are not associated with increased mortality.

Funding

This study was funded by a National Health and Medical Research Foundation of Australia (NHMRC) Project Grant (#1162833).

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来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.