Reducing Early Readmissions after Ventral Hernia Repair with the Americas Hernia Society Quality Collaborative.

Autor:	Poulose BK; The Vanderbilt Hernia Center and Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: benjamin.poulose@vanderbilt.edu., Harris DA; Department of Surgery, Emory University School of Medicine, Atlanta, GA., Phillips S; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN., Janczyk RJ; Department of Surgery, Oakland University/William Beaumont School of Medicine, William Beaumont Hospital, Royal Oak, MI., Yunis J; Center for Hernia Repair, Sarasota Memorial Hospital, Sarasota, FL., Voeller GR; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN., Carbonell A; Department of Surgery, Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC., Warren J; Department of Surgery, Division of Minimal Access and Bariatric Surgery, Greenville Health System, University of South Carolina School of Medicine, Greenville, SC., Stoikes N; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN., Webb D; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN., Hope WW; Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC., Rosen MJ; Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland, OH.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2018 May; Vol. 226 (5), pp. 814-824. Date of Electronic Publication: 2018 Feb 08.
DOI:	10.1016/j.jamcollsurg.2018.01.048
Abstrakt:	Background: Early readmission after ventral hernia repair (VHR) can hinder patient recovery and increase resource use. The objective of this study was to evaluate the effectiveness of the Americas Hernia Society Quality Collaborative Early Readmission Reduction Initiative in reducing early readmissions after VHR. Study Design: Risk factors for early readmission and best practices of surgeons with the lowest readmission rates after VHR were determined through collaborative learning. Two interventions for reducing early readmissions were developed: a structured questionnaire administered to patients within 1 week after discharge from the hospital or an early clinic visit after discharge and before a regularly scheduled postoperative visit. Multivariable logistic regression was used to evaluate the impact of these interventions on early readmission. Results: Use of the questionnaire and early clinic visit was tracked in 3,007 patients. Of these, 343 received the questionnaire (2.6% readmission rate), 761 had an early clinic visit after discharge (3.0% readmission rate), 138 had both (4.3% readmission rate), and 1,765 patients received neither (5.9% readmission rate). After controlling for factors associated with early readmissions, administration of the questionnaire (odds ratio 0.42; 95% CI 0.21 to 0.84; p < 0.05) or having an early clinic visit (odds ratio 0.48; 95% CI 0.30 to 0.76; p < 0.05) were both associated with reduced odds for readmission. Conclusions: The Americas Hernia Society Quality Collaborative Early Readmission Reduction Initiative successfully reduced readmissions after VHR using a structured questionnaire or early clinic visit implemented after discharge and before routine 30-day postoperative follow-up. (Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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