A risk score model of 30-day readmission in ulcerative colitis after colectomy or proctectomy.

Autor:	Sobotka LA; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Husain SG; Department of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Krishna SG; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Hinton A; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA., Pavurula R; Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Conwell DL; Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Zhang C; Department of Gastroenterology, Springfield Regional Medical Center, Mercy Health, Springfield, OH, USA. czhang@mercy.com.
Jazyk:	angličtina
Zdroj:	Clinical and translational gastroenterology [Clin Transl Gastroenterol] 2018 Aug 15; Vol. 9 (8), pp. 175. Date of Electronic Publication: 2018 Aug 15.
DOI:	10.1038/s41424-018-0039-y
Abstrakt:	Introduction: The Center for Medicare and Medicaid Services established 30-day readmission rate as a key metric in measuring high-value, cost-conscious care; therefore, our aim is to develop a risk score for 30-day readmission in ulcerative colitis (UC) patients undergoing colectomy or proctectomy. Methods: This study used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant user file (2011-2015). Patients with UC undergoing colectomy or proctectomy were identified using ICD-9, 10, and CPT codes. Stepwise multivariate analyses were used to determine risk factors associated with readmission including pre-operative conditions, laboratory results, operative variables, and post-operative complications. For readmission risk score assessment, a weighted logistic regression model was built and validated using ACS NSQIP 2011-2014 and 2015 data, respectively. Results: A total of 4797 patients were included with 963 (20%) patients readmitted within 30 days. Potentially modifiable risk factors included deep vein thrombosis, pulmonary embolism, renal insufficiency, wound infection, urinary tract infection, sepsis/septic shock, and pre-existing congestive heart failure. Ten percent of patients with a risk score between 0 and 9 were readmitted, 18.5% with a score between 10 and 19, 52.2% with a score between 20 and 29, and 59.6% in patients with a risk score >29. Conclusions: Multiple potentially preventable risk factors are associated with 30-day readmission following colectomy or proctectomy in UC patients. Higher risk scores are associated with increased risk of unplanned readmission.
Databáze:	MEDLINE
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