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Background
Many patients undergoing below knee amputations (BKA) return for subsequent unplanned operations, hospital readmission, or postoperative complications. This unplanned medical management negatively impacts both patient outcomes and our healthcare system. This study primarily investigates the risk factors for unplanned reoperation following BKA.Methods
Below knee amputations from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from the years 2012–2014 were identified by CPT code 27880 for amputation through the tibia and fibula. Our query identified 4631 BKA cases, including 30 day complications. Multivariate logistic regression modeling was performed on several patient demographic and disease factors to assess for independent predictors of unplanned reoperation. Secondary outcomes of unplanned and related readmissions (related to the procedure), major complications, minor complications, and mortality were also included in the analysis.Results
Of 4631 BKAs identified, 9.63% (446/4631) underwent unplanned reoperations and 8.75% (405/4631) had unplanned and related readmissions. Major complications were experienced by 12.8% (593/4631) and minor complications by 8.7% (401/4631). Thirty day mortality rate was 5.14% (238/4631). The most common procedures for unplanned operations were thigh amputations (128/446, 28.7%), debridement/secondary closure (114/446, 25.6%), and revision leg amputations (46/446, 10.32%). Factors associated with an increased risk of unplanned reoperation included patients transferred from another facility (Adjusted Odds Ratio [AOR]?=?1.28; p?=?.04), recent smokers (AOR?=?1.34; p?=?.02), bleeding disorder (AOR?=?1.30; p?=?.02), and preoperative ventilator use (AOR?=?2.38; p?=?.01).Conclusion
Patients that were ongoing/recent smokers, had diagnosed bleeding disorders, required preoperative ventilator use, or were transferred in from another facility were associated with the highest risks of reoperation following BKA. This patient population experiences high rates of reoperation, readmission, complication, and mortality. 相似文献3.
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目的探讨延续性4C护理对冠心病患者生存质量及再入院率的影响。方法选取2017年10月至2019年1月我院收治的冠心病患者78例,随机分为两组各39例。对照组采用常规护理,观察组采用延续性4C护理。护理4个月后,比较两组患者的生存质量及再入院率。结果护理4个月后,观察组的SF-36各维度评分均显著高于对照组,差异有统计学意义(P<0.05)。观察组的再入院率为5.13%,显著低于对照组的25.64%,差异有统计学意义(P<0.05)。结论冠心病患者采用延续性4C护理有利于改善出院后的生存质量,减少病情反复发作,降低再入院率。 相似文献
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Risk factors for complications and readmission after operative fixation of pediatric femur fractures
Amit Momaya Dustin Baker Shawn Gilbert Brent Ponce 《Journal of children's orthopaedics》2015,9(4):307-311
Purpose
Operative fixation of pediatric femur fractures with intramedullary implants has grown in popularity in recent decades. However, risk factors for short-term adverse events and readmission have not been well studied.Methods
Pediatric patients who underwent intramedullary nailing of a femur fracture between 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Risk factors for any adverse event (AAE) and readmission after intramedullary nailing were evaluated using univariate and multivariate analysis.Results
A total of 522 pediatric patients who underwent intramedullary nailing of the femur during the study period were identified. The mean age of this patient cohort was 10.2 ± 3.8 years. Review of the cases revealed that 18 (3.4 %) patients had AAE and that 20 (3.8 %) patients were readmitted, of whom 13 (2.5 %) underwent a reoperation. Independent risk factors for AAE were a cardiac comorbidity [odds ratio (OR) 12.7, 95 % confidence interval (CI) 1.5, 103.7], open fracture (OR 10.2, 95 % CI 1.4, 74.4), and prolonged operative time (OR 17.5, 95 % CI 6.1, 50.5). Independent risk factors for readmission were a central nervous system disorder (OR 4.5, 95 % CI 1.3, 16.2) and a seizure disorder (OR 4.9, 95 % CI 1.0, 23.5).Conclusions
The results of the multivariate analysis suggest that cardiac comorbidities, open fractures, and prolonged operative time increase the risk for AAE and that central nervous system disorders and seizure disorders may increase the risk for readmission. Surgeons should be aware of these risk factors and counsel the families of pediatric patients who undergo intramedullary nailing of femur fractures. 相似文献8.
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《Journal of vascular surgery》2020,71(1):39-45.e1
ObjectiveLimited data exist comparing the transabdominal and retroperitoneal approaches to open abdominal aortic aneurysm (AAA) repair, especially late mortality and laparotomy-related reinterventions and readmissions. Therefore, we compared long-term rates of mortality, reintervention, and readmission after open AAA repair through a transabdominal compared with a retroperitoneal approach.MethodsWe identified all patients in the Vascular Quality Initiative (VQI) undergoing open AAA repair from 2003 to 2015. Patients with rupture or supraceliac clamp were excluded. We used the VQI linkage to Medicare to ascertain rates of long-term outcomes, including rates of AAA-related and laparotomy-related (ie, hernia, bowel obstruction) reinterventions and readmissions. We used multivariable Cox regression to account for differences in comorbidities, aneurysm details, and operative characteristics.ResultsWe identified 1282 patients in the VQI with linkage to Medicare data, 914 (71%) who underwent a transperitoneal approach and 368 (29%) who underwent a retroperitoneal approach. Patients who underwent a retroperitoneal approach were slightly more likely to have preoperative renal insufficiency but were otherwise similar in terms of demographics and comorbidities. They more often had a clamp above at least one renal artery (61% vs 36%; P < .001) and underwent concomitant renal revascularization (9.5% vs 4.3%; P < .001). Patients who underwent a transabdominal approach more often presented with symptoms (14% vs 9.0%; P < .01) and had a femoral distal anastomosis (15% vs 7.1%; P < .001). There was no difference in 5-year survival (62% vs 61%; log-rank, P = .51). However, patients who underwent a transabdominal approach experienced higher rates of repair-related reinterventions and readmissions (5-year: 42% vs 34%; log-rank, P < .01), even after adjustment for demographic and operative differences (hazard ratio, 1.5; 95% confidence interval, 1.1-1.9; P < .01).ConclusionsA transabdominal exposure for AAA repair is associated with higher rates of late reintervention and readmission than with the retroperitoneal approach, which should be considered when possible in operative decision-making. 相似文献