Risk factors for 90-day readmission and return to the operating room following abdominal operations for Crohn's disease.
Adult
Age Factors
Crohn Disease
/ therapy
Female
Glucocorticoids
/ therapeutic use
Humans
Immunologic Factors
/ therapeutic use
Male
Middle Aged
Patient Readmission
/ statistics & numerical data
Postoperative Complications
/ epidemiology
Postoperative Period
Reoperation
/ statistics & numerical data
Retrospective Studies
Risk Factors
Surgical Procedures, Operative
/ adverse effects
Time Factors
Treatment Outcome
Young Adult
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
12 2019
12 2019
Historique:
received:
20
05
2019
revised:
19
07
2019
accepted:
11
08
2019
pubmed:
25
9
2019
medline:
25
2
2020
entrez:
25
9
2019
Statut:
ppublish
Résumé
This study aimed to determine timing and risk factors for 30- and 90-day unplanned hospital readmissions and return to the operating room. Retrospective case series, including consecutive adult patients with Crohn's disease, undergoing a major abdominal surgical procedure during a 3.5-year inclusion period was performed. The primary outcomes were 0- to 30-day and 30- to 90-day readmission and return to the operating room rates. Univariate and multivariable risk factors for both outcomes at 30 and 90 days were assessed through Cox regression analysis. Of 680 included patients with Crohn's disease, 89 (13.1%) were readmitted within 30 days, 55 (8.1%) within 30-90 days, and 11 (1.6%) in both follow-up periods for a combined 90-day readmission rate of 24.4% (n = 166). Multivariable risk factors for 30-day readmissions were type of procedure performed, corticosteroid use (hazard ratio [HR] 1.71, P = .01), younger age (HR 0.98 per year, P = .01), and prolonged disease duration (HR 1.03 per year, P = .03). No significant risk factors identified for 30- to 90-day readmissions. By 90 days, 76 patients (11.2%) had a return to the operating room (of which 8.8% was within 30 days). Risk factors for 30-day return to the operating room included tobacco use (HR 1.86, P = .04), diabetes (HR 3.30, P = .01), corticosteroid use (HR 3.51, P <.001), and preoperative immunomodulator therapy (HR 2.70, P < .001). Type of surgery, corticosteroid use, younger age, and prolonged disease duration were associated with 30-day hospital readmission, and tobacco use, diabetes, corticosteroid use, and preoperative immunomodulator therapy were risk factors for 30-day return to the operating room. Postoperative biologic therapy did not increase hospital readmission or return to operating room rates within 90 days of surgery.
Sections du résumé
BACKGROUND
This study aimed to determine timing and risk factors for 30- and 90-day unplanned hospital readmissions and return to the operating room.
METHODS
Retrospective case series, including consecutive adult patients with Crohn's disease, undergoing a major abdominal surgical procedure during a 3.5-year inclusion period was performed. The primary outcomes were 0- to 30-day and 30- to 90-day readmission and return to the operating room rates. Univariate and multivariable risk factors for both outcomes at 30 and 90 days were assessed through Cox regression analysis.
RESULTS
Of 680 included patients with Crohn's disease, 89 (13.1%) were readmitted within 30 days, 55 (8.1%) within 30-90 days, and 11 (1.6%) in both follow-up periods for a combined 90-day readmission rate of 24.4% (n = 166). Multivariable risk factors for 30-day readmissions were type of procedure performed, corticosteroid use (hazard ratio [HR] 1.71, P = .01), younger age (HR 0.98 per year, P = .01), and prolonged disease duration (HR 1.03 per year, P = .03). No significant risk factors identified for 30- to 90-day readmissions. By 90 days, 76 patients (11.2%) had a return to the operating room (of which 8.8% was within 30 days). Risk factors for 30-day return to the operating room included tobacco use (HR 1.86, P = .04), diabetes (HR 3.30, P = .01), corticosteroid use (HR 3.51, P <.001), and preoperative immunomodulator therapy (HR 2.70, P < .001).
CONCLUSION
Type of surgery, corticosteroid use, younger age, and prolonged disease duration were associated with 30-day hospital readmission, and tobacco use, diabetes, corticosteroid use, and preoperative immunomodulator therapy were risk factors for 30-day return to the operating room. Postoperative biologic therapy did not increase hospital readmission or return to operating room rates within 90 days of surgery.
Identifiants
pubmed: 31548096
pii: S0039-6060(19)30589-6
doi: 10.1016/j.surg.2019.08.006
pii:
doi:
Substances chimiques
Glucocorticoids
0
Immunologic Factors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1068-1075Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.