住院时间、30天急诊再入院和做梦增强恢复途径在英国结肠直肠手术中的作用

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2025-04-22 DOI:10.1016/j.bja.2025.02.034

Mindy Dawes , Zoë Packman , Ruth A. McDonald , Mark J. Cheetham , Nannette M.T. Gallagher-Ball , Eleanor Warwick , Maria Oyston , Emma McCone , Chris Snowden , Michael Swart , Tim W.R. Briggs , William K. Gray

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引用次数: 0

摘要

背景：增强恢复路径（ERPs）旨在改善择期手术后患者的预后。我们的主要目的是研究英国较短的住院时间（作为替代ERP结果）是否与较高的30天结肠和直肠手术急诊再入院率相关。第二个目的是评估医院在24小时内遵守特定的术后护理包、饮酒、饮食和活动（做梦）与结果的关系。方法回顾性分析来自英国医院事件统计数据集的观察性数据。2014年4月1日至2024年3月31日期间，所有年龄≥17岁、因癌症接受择期结肠或直肠手术的患者均被纳入研究。结果124 580例结肠手术患者和87 036例直肠手术患者中，住院时间较短与较低的30天急诊再入院率显著相关。比较第一（参考）和第四四分位数的住院时间，结肠和直肠手术30天急诊再入院的几率分别增加了2.16（95%可信区间[CI] 2.04-2.30）和2.41 （95% CI 2.26-2.57）。医院信任度的提高与做梦依从性与延长住院时间的患者数量的减少有关(结肠手术：X2=24.885， P<0.001；直肠手术：X2=61.670， P<0.001)，与30天急诊再入院无关。结论：我们没有发现更短的住院时间或更强的做梦依从性与更高的急诊住院率相关的证据。这些发现不应被解释为因果关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England

Background

Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

Methods

This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

Results

Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04–2.30) and 2.41 (95% CI 2.26–2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X²=24.885, P<0.001; rectal surgery: X²=61.670, P<0.001) and was not associated with 30-day emergency readmission.

Conclusions

We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.