大型手术患者非计划性再入院的原因和风险因素：一项回顾性队列研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
非计划性再入院是医疗系统支出和床位占用的重要驱动因素。因此，任何针对该人群减少再入院的干预措施都可能对患者健康状况和医疗预算产生重大影响。
方法
我们开展了一项大规模回顾性队列研究，分析了2011年5月1日至2022年2月1日期间本机构接受重大手术患者的临床数据。本研究主要旨在探讨患者在初次手术后90天内再入院的流行病学特征，以及再入院的原因和风险因素。使用限制性立方样条（restricted cubic splines）建模非线性关系，多变量逻辑回归分析风险因素。
结果
在研究期间，我们共纳入22,143例接受大手术的患者，其中1,801例（12%）出现非计划再入院。全队列中非计划再入院最常见的原因是伤口并发症，该原因在232例（11%）再入院病例中被确认为主要诱因。腹腔手术后，肠梗阻或小肠梗阻是再入院的主要原因，而胸外科手术后肺炎、骨科手术后机械性损伤及心脏手术后伤口并发症则相对少见。出院时血红蛋白浓度<100 g/L（p<0.001）、住院时长14-30天（p<0.001）以及Charlson合并症指数≥2分（p<0.001）与非计划再入院风险增加相关。患者年龄或手术时长与再入院风险无显著关联。
本研究从多个外科专科中确定了重大手术后再入院的原因。对非计划再入院原因及危险因素的深入理解，将有助于制定针对性干预措施，从而最大限度地减轻重大手术后非计划再入院对患者及整个医疗系统造成的负担。
原始文献：Evans K, Makar T, Larsen T, et al. Causes of and risk factors for unplanned readmission in a large cohort of patients undergoing major surgery: a retrospective cohort study. Anaesthesia. 2025 Jun;80(6):652-661. doi: 10.1111/anae.16567. Epub 2025 Feb 16. PMID: 39956642; PMCID: PMC12066936.
Causes of and risk factors for unplanned readmission in a large cohort of patients undergoing major surgery: a retrospective cohort study
ABSTRACT
Introduction: Unplanned hospital readmissions after surgery are substantial drivers of expenditure and bed occupancy within the healthcare system. As a result, any targeted interventions that reduce readmission in this population can have a significant impact on patient well-being and the health budget.
Methods: We performed a large retrospective cohort study analysing data from patients from our institution who underwent major surgery between 1 May 2011 and 1 February 2022. We aimed primarily to study the epidemiology of patients who were readmitted within 90 days of discharge following an index procedure, as well as the reason(s) and risk factors for readmission. These complex, non-linear relationships were modelled with restricted cubic splines.
Results: We identified 22,143 patients undergoing major surgery within the defined study period, of whom 1801 (12%) had an unplanned readmission. The most common reason for unplanned readmission across the entire cohort was wound complication, which was the primary cause identified in 232 (11%) readmissions. Ileus or small bowel obstruction was the primary cause of readmission identified following abdominal surgery, compared with pneumonia following thoracic surgery, mechanical injury following orthopaedic surgery and wound complication following cardiac surgery. A discharge haemoglobin concentration of < 100 g.l-1 (p < 0.001), duration of hospital stay of 14-30 days (p < 0.001) and Charlson comorbidity index score ≥ 2 (p < 0.001) were associated with increased odds of unplanned readmission. No association was found with patient age or duration of surgery.
Discussion: Our study identified the causes of readmission after major surgery from a range of surgical specialties. An improved understanding of the causes of and risk factors for unplanned readmissions will enable the development of targeted interventions that can minimise the burden of unplanned readmissions after major surgery on patients and the larger healthcare system.