ERCP术后病人出院后30天再入院原因预测:单中心经验

时间:2019-10-28 作者:翻译:王浩 审校:张 点击:874次
ERCP术后病人出院后30天再入院原因预测:单中心经验
摘要

引言30天再入院率是一项国家认可的质量评价标准。有将近五分之一的医疗保险参保人在出院后30天内住院,其每年产生的保险费用有260亿美元之多。内镜逆行胰胆管造影术(ERCP)仍然是目前内镜手术中有较高风险和死亡率的手术。我们着眼于研究并预测ERCP术后病人30天再住院的临床特征。
方法 我们对2014-12-1到2018-09-30之间在我中心进行的住院ERCP手术病例进行了一项回顾性图表分析。我们通过对比这些病人的临床特征和预后来确定30天再入院的预测因素。
结果 总共497例符合胆道和胰腺适应症而行ERCP的手术病例,包含483位病人。出院后30天内48例患者产生52次再入院。再入院组和非再入院组的基本人口特征相似。这些再入院病人中合并症明显升高。多变量分析显示当病人合并肝移植术后(OR=4.15)、肝硬化(OR = 3.20)或置入了胰管支架(OR = 2.56)时会导致再入院率的显著提高。对胆道适应症组进行亚组分析显示出院前行胆囊切除术和早期行ERCP可以防止病人再次入院。
结论 有肝移植和肝硬化的病史会增加ERCP术后的再入院率。胰管支架的置入和再入院有关,然而,这一现象与应用胰管支架治疗有关。出院前行胆囊切除术以及早期行ERCP能降低胆道适应症组的再入院率。

Predictorsof30‑Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography: A Single‑Center Experience(IF2.9)
Abstract
Introduction The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicarebenefIciaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP.
Methods We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission.
Results A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identifed. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR=4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56).Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission.
Conclusion A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

翻译:王浩 审校:张立超 侯森林