骨科手术患者再住院的危险因素分析

目的 探讨骨科手术患者再住院的危险因素,以助于加强围手术期的治疗与管理.方法 连续性入选于2008年4月至2013年10月因行骨科手术就诊于我院的1632例患者.详细记录患者的病史及基线等资料,使用单因素和多因素回归分析30天内非计划性再入院的危险因素.结果 研究总共入选816例患者,30天内非计划再住院的发生率为8.4％ （138/1632）.其中102例（73.9％）与手术相关,这些患者中有35例（34.3％）是由于手术部位的感染再住院.多因素回归分析显示,“丧偶”的婚姻状况显著提高了再住院的风险（OR=1.846,95％置信区间[CI] =1.070 ～3.184,P=0.03）.同时,医保患者的再住院风险亦显著较高.所有曾在重症监护室进行治疗的患者的再住院风险最高（OR=2.356,95％CI=1.361 ～4.079,P=0.002）.结论 较长的初次住院时间或进入重症监护病房治疗显著增加了患者30天内再住院的风险.婚姻状况和医保说明了患者的社会和经济资源在一定程度上影响了他们再住院的风险。

Risk Factors for Readmission of Orthopaedic Surgical Patients

Objective To explore the risk factors for readmission of orthopaedic surgical patients. ,so tha we can. strengthen the treatment and management of peri operation period. Methods This is a retrospective cohort study examining of 1632 orthopaedic surgical admissions from the hospital＇ s quality-improvement database. Cases of patients with unplanned readmission within thirty days were subjected to univariate and multivariate analysis to determine the odds ratio （OR） for readmission. Results The estimated cumulative incidence of unplanned thirty-day readmissions was 8.4%. Chart review of readmitted patients showed that 102 readmissions （73.9%） were related to surgical; of these, 35 readmission events （ 34. 3% ） were for infection at the surgical site. Multivariate analysis indicated that marital status of ＂ widowed＂ significantly increased the risk of readmission （ OR = 1. 846; 95% confidence interval [ CI3 = 1. 070-3. 184, P = O. 03 ）. The risk of readmission was significant for patients with Medicaid insurance. Any intensive care unit stay gave the highest OR of readmission （ OR = 2. 356,95% CI = 1. 361-4.079,P = 0. 002） for all demographic groups. Conclusions Longer length of hospital stay or admission to the intensive care unit significantly increased the likelihood of thirty-day readmission, regardless of demographics or discharge disposition. Marital status, Medicaid insurance status, and race may indicate that patient＇s social and economic resources can impact his or her risk of being readmitted to the hospital.