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Predictors of Readmission after Inpatient Plastic Surgery

  • Jain, Umang (Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine) ;
  • Salgado, Christopher (Department of Plastic Surgery, UH Case Medical Center) ;
  • Mioton, Lauren (Vanderbilt School of Medicine) ;
  • Rambachan, Aksharananda (Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine) ;
  • Kim, John Y.S. (Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg, School of Medicine)
  • 투고 : 2013.07.11
  • 심사 : 2013.09.12
  • 발행 : 2014.03.15

초록

Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12- 3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ${\geq}30$) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.

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참고문헌

  1. Bisognano M, Boutwell A. Improving transitions to reduce readmissions. Front Health Serv Manage 2009;25:3-10.
  2. Fischer JP, Wes AM, Nelson JA, et al. Factors associated with readmission following plastic surgery: a review of 10,669 procedures from the 2011 American College of Surgeons National Surgical Quality Improvement Program data set. Plast Reconstr Surg 2013;132:666-74. https://doi.org/10.1097/PRS.0b013e31829acc8c
  3. Chambers M, Clarke A. Measuring readmission rates. BMJ 1990;301:1134-6. https://doi.org/10.1136/bmj.301.6761.1134
  4. Westert GP, Lagoe RJ, Keskimaki I, et al. An international study of hospital readmissions and related utilization in Europe and the USA. Health Policy 2002;61:269-78. https://doi.org/10.1016/S0168-8510(01)00236-6
  5. Saltman RB, Figueras J. Analyzing the evidence on European health care reforms. Health Aff (Millwood) 1998;17:85-108. https://doi.org/10.1377/hlthaff.17.2.85
  6. Ham C, Brommels M. Health care reform in The Netherlands, Sweden, and the United Kingdom. Health Aff (Millwood) 1994;13:106-19. https://doi.org/10.1377/hlthaff.13.5.106
  7. The Burrill Report, Qualcomm Life. Hospital readmissions in Europe [Internet]. Diepoldsau, CH: i-Magazine AG; 2013 [cited 2013 May 29]. Available from: http://www.yumpu.com/en/document/view/14608448/hospital-readmissionsin-europe.
  8. Hackbarth GM, Reischauer R, Miller M. Report to the congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Commission; 2007.
  9. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009;360:1418-28. https://doi.org/10.1056/NEJMsa0803563
  10. Centers for Medicare and Medicaid Services. Readmissions- Reduction-Program [Internet]. Baltimore: Centers for Medi care & Medicaid Services; 2013 [cited 2013 Nov 29]. Available from: http://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html.
  11. Joynt KE, Jha AK. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA 2013;309:342-3. https://doi.org/10.1001/jama.2012.94856
  12. Centers for Medicare and Medicaid Services. Application of incentives to reduce avoidable readmissions to hospitals. Fed Regist 2008;73:23673-5.
  13. Vaduganathan M, Bonow RO, Gheorghiade M. Thirty-day readmissions: the clock is ticking. JAMA 2013;309:345-6. https://doi.org/10.1001/jama.2012.205110
  14. American College of Surgeons, National Surgical Quality Improvement Program. User guide for the 2011 participant use data file [Internet]. Chicago: American College of Surgeons; 2012 [cited 2013 Apr 8]. Available from: http://site.acsnsqip. org/wp-content/uploads/2012/03/2011-User-Guide_Final.pdf.
  15. Birkmeyer JD, Shahian DM, Dimick JB, et al. Blueprint for a new American College of Surgeons: National Surgical Quality Improvement Program. J Am Coll Surg 2008;207:777-82. https://doi.org/10.1016/j.jamcollsurg.2008.07.018
  16. Sleijfer S, Van der Graaf WT, Willemse PH, et al. High-dose methotrexate, vincristine and cisplatin as salvage treatment for relapsed non-seminomatous germ-cell cancer. Anticancer Res 1995;15:1039-42.
  17. Mioton LM, Buck DW 2nd, Rambachan A, et al. Predictors of readmission after outpatient plastic surgery. Plast Reconstr Surg 2014;133:173-80.
  18. Harrop JS, Styliaras JC, Ooi YC, et al. Contributing factors to surgical site infections. J Am Acad Orthop Surg 2012;20:94-101. https://doi.org/10.5435/JAAOS-20-02-094
  19. Beldi G, Bisch-Knaden S, Banz V, et al. Impact of intraoperative behavior on surgical site infections. Am J Surg 2009; 198:157-62. https://doi.org/10.1016/j.amjsurg.2008.09.023
  20. Yost GW, Puher SL, Graham J, et al. Readmission in the 30 days after percutaneous coronary intervention. JACC Cardiovasc Interv 2013;6:237-44.
  21. Blackledge HM, Squire IB. Improving long-term outcomes following coronary artery bypass graft or percutaneous coronary revascularisation: results from a large, population-based cohort with first intervention 1995-2004. Heart 2009;95:304-11.
  22. Krumholz HM, Merrill AR, Schone EM, et al. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes 2009;2:407-13. https://doi.org/10.1161/CIRCOUTCOMES.109.883256
  23. Ogunleye AA, de Blacam C, Curtis MS, et al. An analysis of delayed breast reconstruction outcomes as recorded in the American College of Surgeons National Surgical Quality Improvement Program. J Plast Reconstr Aesthet Surg 2012; 65:289-94. https://doi.org/10.1016/j.bjps.2011.09.031
  24. Joynt KE, Jha AK. Thirty-day readmissions: truth and consequences. N Engl J Med 2012;366:1366-9. https://doi.org/10.1056/NEJMp1201598
  25. Sellers MM, Merkow RP, Halverson A, et al. Validation of new readmission data in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013;216:420-7. https://doi.org/10.1016/j.jamcollsurg.2012.11.013

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