BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence ph...BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.展开更多
BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patien...BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patient safety and increasing the costs.AIM To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.METHODS One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022.The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR,using univariate and multivariate analyses.Variables such as the demographic characteristics,comorbidities,laboratory and imaging characteristics,dietary status,operative time,number of kidney punctures,blood loss,urinary tract infections,and the receipt of instructions for catheter care and activities of daily living were included.A risk score was created.RESULTS The mean age of patients with HR(44.4±12.7 years)and without HR(43.9±12.6 years)was similar(P=0.847).The overall stone-free rate was 88.8%.The total complication rate was 32.3%(52 patients),and the highest grade was IIIa,according to the modified Clavein grading system,resulting in an HR rate of 22.4%.History of preoperative pyuria(P=0.001),hydronephrosis(P=0.001)and mean stone size(P=0.012),multiple renal punctures(P<0.001),double J stent(P=0.033),total operative time(P=0.001),intraoperative injury(P=0.011),postoperative urinary tract infection(P<0.001),and inadequate instructions for urethral catheter(P=0.001)and activity daily living(P=0.048)were significantly associated with HR after PNL.On multivariate analysis,only preoperative pyuria(P=0.004),intraoperative injury(P=0.001),and inadequate instructions on urethral catheter care(P=0.035)were associated with HR.The risk score of the independent predictors was 0-17;0-4(low risk),5-9(moderate risk),and 10-17(high risk).CONCLUSION The rate of unplanned HR after PNL was relatively high(22.4%).The presence of pus cells in the preoperative urine analysis,intraoperative injury,and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL.Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.展开更多
From the perspective of unplanned readmission in patients with enterostomy,this study reviewed the incidence,influencing factors and intervention measures,to provide reference for increasing the attention of medical s...From the perspective of unplanned readmission in patients with enterostomy,this study reviewed the incidence,influencing factors and intervention measures,to provide reference for increasing the attention of medical staff,early detection of risk factors and formulation of personalized intervention measures.展开更多
BACKGROUND Gastrointestinal(GI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource utilization.Finding ways to reduce the economic burden of healthcare costs and the impa...BACKGROUND Gastrointestinal(GI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource utilization.Finding ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial importance.Thirty-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI ailments.AIM To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United States.METHODS A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI diseases.The 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality(index admission,calendar-year),hospitalization costs,and thirty-day readmission and secondary outcomes were predictors of thirty-day readmission.RESULTS For the year 2013,the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about$25 billion.The thirty-day readmission rates were highest for chronic liver disease(25.4%),Clostridium difficile(C.difficile)infection(23.6%),functional/motility disorders(18.5%),inflammatory bowel disease(16.3%),and GI bleeding(15.5%).The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease(6.1%and 12.6%),C.difficile infection(2.3%and 6.1%),and GI bleeding(2.2%and 5.0%),respectively.Thirty-day readmission correlated with any subsequent admission mortality(r=0.798,P=0.001).Medicare/Medicaid insurances,≥3 Elixhauser comorbidities,and length of stay>3 d were significantly associated with thirty-day readmission for all the thirteen GI diseases.CONCLUSION Preventable and non-chronic GI disease contributed to a significant economic and health burden comparable to chronic GI conditions,providing a window of opportunity for improving healthcare delivery in reducing its burden.展开更多
BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to...BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.展开更多
BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and imp...BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been give...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.展开更多
Background: The growing use of web-based patient portals offers patients valuable tools for accessing health information, communicating with healthcare providers, and engaging in self-management. However, the influenc...Background: The growing use of web-based patient portals offers patients valuable tools for accessing health information, communicating with healthcare providers, and engaging in self-management. However, the influence of educating patients on these portals’ functionality on clinical outcomes, such as all-cause readmission rates, remains underexplored. Objective: This research proposal tested the hypothesis that educating a subset of patients with Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF), on how to effectively access and utilize the functionality of web-based patient portals can reduce all-cause readmission rates. Methods: We performed a prospective, quasi-experimental study at Bon Secours St. Mary’s Hospital in Richmond, Virginia, USA;dividing participants into an intervention group, receiving education about accessing and navigating “My Chart”, the Bon Secours Web based portal, and a control group, receiving standard care. We then compared 30-day readmission rates, patient engagement, and self-management behaviors between the groups. Data was analyzed using statistical tests to assess the intervention’s impact. Results: We projected that educated patients will exhibit lower readmission rates, improved engagement, and better self-management. The results of the study showed that there was a significant decrease in 30-day readmissions in the intervention group in comparison with the control group (22.7% and 40.9%, respectively). This reduction of 18. 2% of readmissions evaluated here for a trial of meaningful clinical effect is statistically insignificant (p = 0. 184). The practical significance of the intervention is considered small-to-moderate (Cramer V = 0. 20) suggesting that the observed difference has a potential clinical importance even though the difference was not statistically significant. Conclusion: These results imply that the proposed educational intervention might have a positive impact on readmissions;nonetheless, the patient’s characteristics that make him or her capable of readmission cannot be changed and are assessed by the RoR (Risk of Readmission) score. The potential impact of the intervention may be offset, in part, by these baseline risk factors. The study’s power may be limited by sample size, potentially affecting the detection of significant differences. Future studies with larger, multi-center samples and longer follow-up periods are recommended to confirm these findings.展开更多
Background Heart failure （HF） is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce th...Background Heart failure （HF） is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged 〉 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male （51.3%）, almost half were smokers （46.2%）, and the majority received 〈 six years of formal education. Most of the HF patients （87.2%） belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15± 20.31 mL. The HF patients who attended the clinic （n = 38, 75.13 ± 5.89 years） were significantly younger than those who did not attend the clinic （n = 40, 79.53 ± 6.96 years） （P = 0.04）, and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio （OR）： 7.40; P 〈 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality （n = 4） than those who did not attend （n = 14）. However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A signifi- cant reduction in systolic blood pressure IF （2, 94） = 3.39, P = 0.04] and diastolic blood pressure [F （2, 94） = 8.48, P 〈 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.展开更多
Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conduct...Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.展开更多
AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with d...AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013(n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariateanalyses were performed to describe variables associated with readmission.RESULTS One hundred thirty-two patients(59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.CONCLUSION Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.展开更多
Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes...Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes is unknown.This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.Methods:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were screened.The primary outcome was 90-day readmission after discharge.Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.Results:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did not.Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did not.For the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two groups.Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission causality.Conclusions:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.展开更多
AIM: To identify rates of post-discharge complications(PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.METHODS: We used the 2005-2013 American College of Surgeons Nati...AIM: To identify rates of post-discharge complications(PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.METHODS: We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication(Group 1), only pre-discharge complication(Group 2), and PDC patients(Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing postdischarge complication, and risk ratios were estimated.RESULTS: 4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay(LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection(41.0% vs 19.3%, P < 0.001), venous thromboembolism(16.3% vs 8.9%, P < 0.001), and organ space surgical site infection(17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation(39.5% vs 22.4%, P < 0.001) and readmission(66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI(18.5-25).CONCLUSION: PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-discharge, with possible prevention programs at discharge.展开更多
Background: Repeat hospitalizations in veterans with inflammatory bowel disease(IBD) are under studied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD we...Background: Repeat hospitalizations in veterans with inflammatory bowel disease(IBD) are under studied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.Methods: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center(MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.Results: There were 130 unique patients(56.9% with Crohn's disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8±15.2 years. The median time to re-hospitalization was 26 days(IQR 10-49), with 30-and 90-day readmission rates of 17.3%(35/202) and 29.2%(59/202), respectively. Reasons for all-cause readmission were IBD-related(71.2%), scheduled surgery(3.4%) and non-gastrointestinal causes(25.4%). The following reasons were independently associated with 90-day readmission: Crohn's disease(OR 3.90; 95% CI 1.82-8.90), use of antidepressants(OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician(PCP)(OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist(GI)(OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.Conclusion: Early readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn's disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.展开更多
BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission af...BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.展开更多
Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfa...Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials（RCTs） published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions（Version5.1.0） and determined with an I^2 statistic.Results：A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI（0.38,0.68）,P 〈 0.00001]and18 month time points[RR = 0.56,95%CI（0.45,0.69）,P 〈 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI（0.62,0.84）,P 〈 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions：Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.展开更多
AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODS A retrospective analysis of the nationwide readmission database(NRD) was perf...AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODS A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTS Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age < 40(OR: 1.39; CI: 1.19-1.64), age 40-64(OR: 1.19; CI: 1.09-1.30), Medicaid(OR: 1.21; CI: 1.04-1.41) and Medicare coverage(OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < 0.001.CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.展开更多
ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a d...ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a direct renin inhibitor, when added to standard therapy, would reduce the rate of cardiovascular （CV） death or HF rehospitalization among HHF patients. Design, Setting, and Participants International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission. Eligible patients were 18 years or older with left ventricular ejection fraction （LVEF） 40% or less,展开更多
BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because...BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because of their smaller sample sizes,differences in the definition of pneumonia,joint pooling of the in-hospital and post-discharge deaths and lower generalizability.AIM To estimate the effect of various risk factors on the rate of hospital readmissions in patients with pneumonia.METHODS Systematic search was conducted in PubMed Central,EMBASE,MEDLINE,Cochrane library,ScienceDirect and Google Scholar databases and search engines from inception until July 2021.We used the Newcastle Ottawa(NO)scale to assess the quality of published studies.A meta-analysis was carried out with random-effects model and reported pooled odds ratio(OR)with 95%confidence interval(CI).RESULTS In total,17 studies with over 3 million participants were included.Majority of the studies had good to satisfactory quality as per NO scale.Male gender(pooled OR=1.22;95%CI:1.16-1.27),cancer(pooled OR=1.94;95%CI:1.61-2.34),heart failure(pooled OR=1.28;95%CI:1.20-1.37),chronic respiratory disease(pooled OR=1.37;95%CI:1.19-1.58),chronic kidney disease(pooled OR=1.38;95%CI:1.23- 1.54) and diabetes mellitus (pooled OR = 1.18;95%CI: 1.08-1.28) had statistically significantassociation with the hospital readmission rate among pneumonia patients. Sensitivity analysisshowed that there was no significant variation in the magnitude or direction of outcome,indicating lack of influence of a single study on the overall pooled estimate.CONCLUSIONMale gender and specific chronic comorbid conditions were found to be significant risk factors forhospital readmission among pneumonia patients. These results may allow clinicians and policymakersto develop better intervention strategies for the patients.展开更多
AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesi...AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.展开更多
文摘BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.
文摘BACKGROUND Percutaneous nephrolithotomy(PNL)is the standard treatment for medium-sized and large kidney stones.Many potential complications of PNL may warrant hospital readmission(HR)after discharge,threatening patient safety and increasing the costs.AIM To estimate the rate of unplanned HR after PNL and identify its urological and nursing-related predictors.METHODS One hundred sixty-one patients were prospectively studied for HR after PNL from April 2022 to December 2022.The relevant urological and nursing-related characteristics of patients with and without unplanned HR after PNL were studied for association with HR,using univariate and multivariate analyses.Variables such as the demographic characteristics,comorbidities,laboratory and imaging characteristics,dietary status,operative time,number of kidney punctures,blood loss,urinary tract infections,and the receipt of instructions for catheter care and activities of daily living were included.A risk score was created.RESULTS The mean age of patients with HR(44.4±12.7 years)and without HR(43.9±12.6 years)was similar(P=0.847).The overall stone-free rate was 88.8%.The total complication rate was 32.3%(52 patients),and the highest grade was IIIa,according to the modified Clavein grading system,resulting in an HR rate of 22.4%.History of preoperative pyuria(P=0.001),hydronephrosis(P=0.001)and mean stone size(P=0.012),multiple renal punctures(P<0.001),double J stent(P=0.033),total operative time(P=0.001),intraoperative injury(P=0.011),postoperative urinary tract infection(P<0.001),and inadequate instructions for urethral catheter(P=0.001)and activity daily living(P=0.048)were significantly associated with HR after PNL.On multivariate analysis,only preoperative pyuria(P=0.004),intraoperative injury(P=0.001),and inadequate instructions on urethral catheter care(P=0.035)were associated with HR.The risk score of the independent predictors was 0-17;0-4(low risk),5-9(moderate risk),and 10-17(high risk).CONCLUSION The rate of unplanned HR after PNL was relatively high(22.4%).The presence of pus cells in the preoperative urine analysis,intraoperative injury,and receiving inadequate instructions on urethral catheter care were independent predictors of HR after PNL.Combined studying of the urological and nursing-related predictors may promote the implementation of enhanced recovery protocols after PNL.
文摘From the perspective of unplanned readmission in patients with enterostomy,this study reviewed the incidence,influencing factors and intervention measures,to provide reference for increasing the attention of medical staff,early detection of risk factors and formulation of personalized intervention measures.
文摘BACKGROUND Gastrointestinal(GI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource utilization.Finding ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial importance.Thirty-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI ailments.AIM To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United States.METHODS A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI diseases.The 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality(index admission,calendar-year),hospitalization costs,and thirty-day readmission and secondary outcomes were predictors of thirty-day readmission.RESULTS For the year 2013,the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about$25 billion.The thirty-day readmission rates were highest for chronic liver disease(25.4%),Clostridium difficile(C.difficile)infection(23.6%),functional/motility disorders(18.5%),inflammatory bowel disease(16.3%),and GI bleeding(15.5%).The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease(6.1%and 12.6%),C.difficile infection(2.3%and 6.1%),and GI bleeding(2.2%and 5.0%),respectively.Thirty-day readmission correlated with any subsequent admission mortality(r=0.798,P=0.001).Medicare/Medicaid insurances,≥3 Elixhauser comorbidities,and length of stay>3 d were significantly associated with thirty-day readmission for all the thirteen GI diseases.CONCLUSION Preventable and non-chronic GI disease contributed to a significant economic and health burden comparable to chronic GI conditions,providing a window of opportunity for improving healthcare delivery in reducing its burden.
文摘BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.
文摘BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.
文摘Background: The growing use of web-based patient portals offers patients valuable tools for accessing health information, communicating with healthcare providers, and engaging in self-management. However, the influence of educating patients on these portals’ functionality on clinical outcomes, such as all-cause readmission rates, remains underexplored. Objective: This research proposal tested the hypothesis that educating a subset of patients with Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF), on how to effectively access and utilize the functionality of web-based patient portals can reduce all-cause readmission rates. Methods: We performed a prospective, quasi-experimental study at Bon Secours St. Mary’s Hospital in Richmond, Virginia, USA;dividing participants into an intervention group, receiving education about accessing and navigating “My Chart”, the Bon Secours Web based portal, and a control group, receiving standard care. We then compared 30-day readmission rates, patient engagement, and self-management behaviors between the groups. Data was analyzed using statistical tests to assess the intervention’s impact. Results: We projected that educated patients will exhibit lower readmission rates, improved engagement, and better self-management. The results of the study showed that there was a significant decrease in 30-day readmissions in the intervention group in comparison with the control group (22.7% and 40.9%, respectively). This reduction of 18. 2% of readmissions evaluated here for a trial of meaningful clinical effect is statistically insignificant (p = 0. 184). The practical significance of the intervention is considered small-to-moderate (Cramer V = 0. 20) suggesting that the observed difference has a potential clinical importance even though the difference was not statistically significant. Conclusion: These results imply that the proposed educational intervention might have a positive impact on readmissions;nonetheless, the patient’s characteristics that make him or her capable of readmission cannot be changed and are assessed by the RoR (Risk of Readmission) score. The potential impact of the intervention may be offset, in part, by these baseline risk factors. The study’s power may be limited by sample size, potentially affecting the detection of significant differences. Future studies with larger, multi-center samples and longer follow-up periods are recommended to confirm these findings.
文摘Background Heart failure （HF） is a physically and socially debilitating disease that carries the burden of hospital re-admission and mortality. As an aging society, Hong Kong urgently needs to find ways to reduce the hospital readmission of HF patients. This study evaluates the effects of a nurse-led HF clinic on the hospital readmission and mortality rates among older HF patients in Hong Kong. Methods This study is a retrospective data analysis that compares HF patient in a nurse-led HF clinic in Hong Kong compared with HF patients who did not attend the clinic. The nurses of this clinic provide education on lifestyle modification and symptom monitoring, as well as titrate the medications and measure biochemical markers by following established protocols. This analysis used the socio-demographic and clinical data of HF patients who were aged 〉 65 years old and stayed in the clinic over a six-month period. Results The data of a total of 78 HF patients were included in this data analysis. The mean age of the patients was 77.38 ± 6.80 years. Approximately half of the HF patients were male （51.3%）, almost half were smokers （46.2%）, and the majority received 〈 six years of formal education. Most of the HF patients （87.2%） belonged to classes II and III of the New York Heart Association Functional Classification, with a mean ejection fraction of 47.15± 20.31 mL. The HF patients who attended the clinic （n = 38, 75.13 ± 5.89 years） were significantly younger than those who did not attend the clinic （n = 40, 79.53 ± 6.96 years） （P = 0.04）, and had lower recorded blood pressure. No other statistically significant difference existed between the socio-demographic and clinical characteristics of the two groups. The HF patients who did not attend the nurse-led HF clinic demonstrated a significantly higher risk of hospital readmission [odd ratio （OR）： 7.40; P 〈 0.01] than those who attended after adjusting for the effect of age and blood pressure. In addition, HF patients who attended the clinic had lower mortality （n = 4） than those who did not attend （n = 14）. However, such a difference did not reach statistical significance when the effects of age and blood pressure were adjusted. A signifi- cant reduction in systolic blood pressure IF （2, 94） = 3.39, P = 0.04] and diastolic blood pressure [F （2, 94） = 8.48, P 〈 0.01] was observed among the HF patients who attended the clinic during the six-month period. Conclusions The finding of this study suggests the important role of nurse-led HF clinics in reducing healthcare burden and improving patient outcomes among HF patients in Hong Kong.
基金This work was supported by the National Key Clinical Specialist Construction Projects of China[No.(2018)292]
文摘Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.
文摘AIM To reduce readmissions and improve patient outcomes in cirrhotic patients through better understanding of readmission predictors.METHODS We performed a single-center retrospective study of patients admitted with decompensated cirrhosis from January 1, 2011 to December 31, 2013(n = 222). Primary outcomes were time to first readmission and 30-d readmission rate due to complications of cirrhosis. Clinical and demographic data were collected to help describe predictors of readmission, along with care coordination measures such as post-discharge status and outpatient follow-up. Univariate and multivariateanalyses were performed to describe variables associated with readmission.RESULTS One hundred thirty-two patients(59.4%) were readmitted at least once during the study period. Median time to first and second readmissions were 54 and 93 d, respectively. Thirty and 90-d readmission rates were 20.7 and 30.1 percent, respectively. Predictors of 30-d readmission included education level, hepatic encephalopathy at index, ALT more than upper normal limit and Medicare coverage. There were no statistically significant differences in readmission rates when stratified by discharge disposition, outpatient follow-up provider or time to first outpatient visit.CONCLUSION Readmissions are challenging aspect of care for cirrhotic patients and risk continues beyond 30 d. More initiatives are needed to develop enhanced, longitudinal post-discharge systems.
基金supported by grants from the National Natural Science Foundation of China (82070665 and 81900592)
文摘Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes is unknown.This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.Methods:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were screened.The primary outcome was 90-day readmission after discharge.Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.Results:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did not.Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did not.For the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two groups.Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission causality.Conclusions:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.
文摘AIM: To identify rates of post-discharge complications(PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.METHODS: We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication(Group 1), only pre-discharge complication(Group 2), and PDC patients(Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing postdischarge complication, and risk ratios were estimated.RESULTS: 4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay(LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection(41.0% vs 19.3%, P < 0.001), venous thromboembolism(16.3% vs 8.9%, P < 0.001), and organ space surgical site infection(17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation(39.5% vs 22.4%, P < 0.001) and readmission(66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI(18.5-25).CONCLUSION: PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-discharge, with possible prevention programs at discharge.
基金supported by the Department of Veterans Affairs, and the Minneapolis Health Services Research and Development (HSR&D) Service Center of Innovation and VA Health Care System
文摘Background: Repeat hospitalizations in veterans with inflammatory bowel disease(IBD) are under studied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.Methods: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center(MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.Results: There were 130 unique patients(56.9% with Crohn's disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8±15.2 years. The median time to re-hospitalization was 26 days(IQR 10-49), with 30-and 90-day readmission rates of 17.3%(35/202) and 29.2%(59/202), respectively. Reasons for all-cause readmission were IBD-related(71.2%), scheduled surgery(3.4%) and non-gastrointestinal causes(25.4%). The following reasons were independently associated with 90-day readmission: Crohn's disease(OR 3.90; 95% CI 1.82-8.90), use of antidepressants(OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician(PCP)(OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist(GI)(OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.Conclusion: Early readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn's disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.
文摘BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)readmission.AIM To identify the incidence,causes,and outcomes of ICU readmission after LDLT.METHODS A retrospective cohort study was conducted on patients who underwent LDLT.The collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and outcomes.Patients were divided into two groups according to ICU readmission after hospital discharge.Risk factors for ICU readmission were identified in univariate and multivariate analyses.RESULTS The present study included 299 patients.Thirty-one(10.4%)patients were readmitted to the ICU after discharge.Patients who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.
基金Funding from Jiangsu Provincial Commission of Health and Family Planning Foundation(H2015032)
文摘Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials（RCTs） published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions（Version5.1.0） and determined with an I^2 statistic.Results：A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI（0.38,0.68）,P 〈 0.00001]and18 month time points[RR = 0.56,95%CI（0.45,0.69）,P 〈 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI（0.62,0.84）,P 〈 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions：Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.
文摘AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODS A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTS Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age < 40(OR: 1.39; CI: 1.19-1.64), age 40-64(OR: 1.19; CI: 1.09-1.30), Medicaid(OR: 1.21; CI: 1.04-1.41) and Medicare coverage(OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < 0.001.CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.
文摘ABSTRACT Importance Hospitalizations for heart failure （HHF） represent a major health burden, with high rates of early postdischarge rehospitalization and mortality. Objective To investigate whether aliskiren, a direct renin inhibitor, when added to standard therapy, would reduce the rate of cardiovascular （CV） death or HF rehospitalization among HHF patients. Design, Setting, and Participants International, double-blind, placebo-controlled study that randomized hemodynamically stable HHF patients a median 5 days after admission. Eligible patients were 18 years or older with left ventricular ejection fraction （LVEF） 40% or less,
文摘BACKGROUND Factors that are associated with the short-term rehospitalization have been investigated previously in numerous studies.However,the majority of these studies have not produced any conclusive results because of their smaller sample sizes,differences in the definition of pneumonia,joint pooling of the in-hospital and post-discharge deaths and lower generalizability.AIM To estimate the effect of various risk factors on the rate of hospital readmissions in patients with pneumonia.METHODS Systematic search was conducted in PubMed Central,EMBASE,MEDLINE,Cochrane library,ScienceDirect and Google Scholar databases and search engines from inception until July 2021.We used the Newcastle Ottawa(NO)scale to assess the quality of published studies.A meta-analysis was carried out with random-effects model and reported pooled odds ratio(OR)with 95%confidence interval(CI).RESULTS In total,17 studies with over 3 million participants were included.Majority of the studies had good to satisfactory quality as per NO scale.Male gender(pooled OR=1.22;95%CI:1.16-1.27),cancer(pooled OR=1.94;95%CI:1.61-2.34),heart failure(pooled OR=1.28;95%CI:1.20-1.37),chronic respiratory disease(pooled OR=1.37;95%CI:1.19-1.58),chronic kidney disease(pooled OR=1.38;95%CI:1.23- 1.54) and diabetes mellitus (pooled OR = 1.18;95%CI: 1.08-1.28) had statistically significantassociation with the hospital readmission rate among pneumonia patients. Sensitivity analysisshowed that there was no significant variation in the magnitude or direction of outcome,indicating lack of influence of a single study on the overall pooled estimate.CONCLUSIONMale gender and specific chronic comorbid conditions were found to be significant risk factors forhospital readmission among pneumonia patients. These results may allow clinicians and policymakersto develop better intervention strategies for the patients.
文摘AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.
