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首页> 外文期刊>Surgical Endoscopy >Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database
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Trends and risk factors for 30-day readmissions in patients with acute cholangitis: analysis from the national readmission database

机译：急性胆管炎患者为期30天阅览室的趋势和危险因素：来自国家入院数据库的分析

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摘要

Introduction Acute cholangitis (AC) can be associated with significant mortality and high risk of readmissions, if not managed promptly. We used national readmission database (NRD) to identify trends and risk factors associated with 30-day readmissions in patients with AC. Methods We conducted a retrospective cohort study of adult patients admitted with AC from 2010-2014 and Q1-Q3 of 2015 by extracting data from NRD. Initial admission with a primary diagnosis of acute cholangitis (ICD-9 code: 576.1) was considered as the index admission and any admission after index admission was considered a readmission regardless of the primary diagnosis. Multivariable regression analyses were performed to assess the association. Results From 52,906 AC index admissions, overall 30-day readmission rate was 21.48% without significant differences in the readmission rates across the study period. There was significant increase in the overall hospital charges for readmissions, while a significant reduction in the death rate was observed during the first readmission. Recurrent cholangitis (14%), septicemia (6.4%), and mechanical complication of bile duct prosthesis (3%) were the most common reasons for readmissions. The risk of readmission was significantly higher in patients with pancreatic neoplasm (OR 1.6, 95% CI 1.4-1.8), those who underwent percutaneous biliary procedures (OR 1.4, 95% CI 1.2-1.6), and who had an acute respiratory failure (OR 1.2, 95% CI 1.0-1.15). Other factors contributing to increased risk of readmissions included patients with Charleston comorbidity index > 3, diabetes, and length of stay > 3 days. Readmission risk was significantly lower in patients who underwent ERCP (OR 0.80, 95% CI 0.73-0.88) or cholecystectomy (OR 0.54, 95% CI 0.43-0.69). Conclusions AC is associated with a high 30-day readmission rate of over 21%. Patients with malignant biliary obstruction, increased comorbidities, and those who undergo percutaneous drainage rather than ERCP seem to be at the highest risk.
机译：导言如果不及时处理，急性胆管炎（AC）可能会导致显著的死亡率和再入院的高风险。我们使用国家再入院数据库（NRD）来确定与AC患者30天再入院相关的趋势和风险因素。方法我们通过从NRD中提取数据，对2010-2014年和2015年第一季度收治的成年AC患者进行回顾性队列研究。初次入院并初步诊断为急性胆管炎（ICD-9代码：576.1）被视为指标入院，无论初次诊断如何，指标入院后的任何入院均被视为再入院。进行多变量回归分析以评估相关性。结果在52906例AC指数入院患者中，总体30天再入院率为21.48%，在整个研究期间，再入院率没有显著差异。再次入院的总体住院费用显著增加，而首次再次入院期间的死亡率显著降低。复发性胆管炎（14%）、败血症（6.4%）和人工胆管机械并发症（3%）是再入院的最常见原因。胰腺肿瘤患者（OR 1.6，95%可信区间1.4-1.8）、经皮胆道手术患者（OR 1.4，95%可信区间1.2-1.6）和急性呼吸衰竭患者（OR 1.2，95%可信区间1.0-1.15）的再入院风险显著较高。导致再入院风险增加的其他因素包括查尔斯顿共病指数>3、糖尿病和住院时间>3天的患者。接受ERCP（OR 0.80，95%可信区间0.73-0.88）或胆囊切除术（OR 0.54，95%可信区间0.43-0.69）的患者再入院风险显著降低。结论AC患者30天再入院率高达21%以上。恶性胆道梗阻、合并症增加以及接受经皮穿刺引流而非ERCP的患者的风险最高。

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  • 来源
    《Surgical Endoscopy》 |2021年第1期|共9页
  • 作者

    Parikh Malav P.; Garg Rajat; Chittajallu Vibhu; Gupta Niyati; Sarvepalli Shashank; Lopez Rocio; Thota Prashanthi N.; Siddiki Hassan; Bhatt Amit; Chahal Prabhleen; Jang Sunguk; Stevens Tyler; Vargo John; McCullough Arthur; Sanaka Madhusudhan R.;

  • 作者单位

    Cleveland Clin Fdn Dept Hosp Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Hosp Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Hosp Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Hosp Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Hosp Med 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Biostat &

    Quantitat Hlth Sci 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

    Cleveland Clin Fdn Dept Gastroenterol &

    Hepatol 9500 Euclid Ave Cleveland OH 44195 USA;

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  • 正文语种 eng
  • 中图分类 诊断学;
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