胸外科手术患者出院后90 d内非计划再次入院分析

目的总结分析北京协和医院胸外科手术患者再次入院的发生率、发生时间、主要原因以及再次入院需要承担的经济负担，以期为减少术后患者再次入院提供借鉴。 方法回顾性收集北京协和医院2011至2020年胸外科出院后90 d内非计划再入院患者的临床病历资料。根据手术部位、手术入路和再入院间隔时间进行亚组分析，并对组间差异进行比较。 结果共纳入111名患者。所有患者的90 d和30 d非计划再入院率分别为0.71%和0.55%。非计划再入院的最常见原因是大量胸腔积液（36.9%）、感染（31.5%）、漏气（19.8%）。该研究的总体再入院时间为14（19.3±19.4）d。非计划再入院患者的平均二次住院时间为13.1（12.0）d。住院费用为（19 533.6±18 918.7）元，总体的有创操作率为79.3%。 结论胸外科手术患者的非计划再入院是一个小概率事件。接受食管手术和非微创手术是非计划再入院的危险因素。大量胸腔积液、感染和漏气是所有患者非计划再入院的最常见原因。出院后的第2～3周是再入院风险最高的时间段。计划外的再入院会给患者带来额外的有创伤害、时间成本和经济负担。

Analysis of unplanned readmissions within 90 days after discharge of thoracic surgery patients

ObjectiveTo summarize and analyze the data on the incidence, time, main reasons, and financial burden of readmissions for thoracic surgery patients in Peking Union Medical College Hospital, to help reduce postoperative readmissions. MethodsThe clinical medical records of patients with unplanned readmission within 90 days after discharge from the Department of Thoracic Surgery in our hospital from 2011 to 2020 were retrospectively collected. Subgroup analyses were performed according to the surgical site, surgical approach, and readmission interval. Differences between means were compared using t-tests, and chi-square tests were used to assess differences between ratios. A statistically significant difference was defined as P<0.05. ResultsA total of 111 patients met the study inclusion criteria, and the 90-day and 30-day unplanned readmission rates were 0.71% and 0.55%, respectively. The most common reasons for unplanned readmission were massive pleural effusion (36.9%) , infection (31.5%) , and air leak (19.8%) . The overall median readmission time for the study was 14 days, and the mean readmission time was 19.3±19.4 days. The mean duration of second hospital stay for patients with unplanned readmissions was 13.1 (12.0) days. The average hospitalization cost was 19,533.6±18,918.7 yuan, and the overall invasive operation rate was 79.3%. ConclusionsOur study shows that unplanned readmission of patients undergoing thoracic surgery is a small probability event. Receipt of esophageal surgery and non-minimally invasive surgery are risk factors for unplanned readmission. Massive pleural effusion, infection, and air leaks were the most common causes of unplanned readmissions in all patients. The 2–3 weeks after discharge is the period with the highest risk of readmission. Unplanned readmissions impose additional invasive harm, time cost, and financial burden on patients.