Factors Associated With 30-Day Readmissions After Transsphenoidal Pituitary Surgery.

IF 3.7 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-10-11 DOI:10.1016/j.eprac.2024.10.003
Aditi Kumar, Mona Vahidi Rad, Alyssa K McGary, Janna C Castro, Curtiss B Cook
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Abstract

Purpose: Determine the association between clinical and demographic factors and 30-day readmission risk after pituitary surgery.

Methods: Patients undergoing pituitary surgery between January 2018 and December 2022 were retrospectively reviewed. Cases were extracted from a converged electronic health record that included surgeries performed at the Midwest, Southeast, and Southwest campuses of the same healthcare Enterprise. Variables were compared between patients with 30-day readmission following discharge after pituitary surgery (N = 83) and a randomly sampled patient cohort with pituitary surgery but no readmission within 30 days (N = 174).

Results: In a multivariable regression model looking at the relationship between patient characteristics and readmission risk, every increase in the Medicare Severity Diagnosis Related Group score resulted in a nearly 2.3-fold increase in the risk of readmission (OR = 2.335, 95% CI 1.050, 5.562, P = .045). The presence of arginine vasopressin deficiency increased the odds of readmission by more than 2-fold (OR = 2.784, 95% CI 1.118, 7.124, P = .029). The Midwest site was observed to have a nearly 67% decrease in readmission risk compared to the Southwest site (OR = 0.334, 95% CI 0.134, 0.813, P = .016), with the Southeast site being comparable to the Southwest.

Conclusion: Our study identifies postoperative arginine vasopressin deficiency, greater co-morbidities, and geographic location as risk factors for 30-day readmission after pituitary surgery. Further investigation is required to determine how site-specific care processes can be adopted to lower readmission risk at other locations in the same healthcare enterprise.

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经蝶垂体手术后 30 天再入院的相关因素。
目的:确定垂体手术后临床和人口学因素与 30 天再入院风险之间的关联:对 2018 年 1 月至 2022 年 12 月间接受垂体手术的患者进行回顾性研究。病例从融合的电子病历中提取,其中包括在同一医疗企业的中西部、东南部和西南部校区进行的手术。对垂体手术后出院 30 天内再次入院的患者(83 例)和随机抽样的垂体手术后 30 天内未再次入院的患者队列(174 例)进行了变量比较:在研究患者特征与再入院风险关系的多变量回归模型中,医疗保险严重程度诊断相关组评分每增加一项,再入院风险就增加近2.3倍(OR=2.335,95% CI 1.050,5.562,p=0.045)。存在 AVP 缺乏症的患者再次入院的几率增加了 2 倍多(OR=2.784,95% CI 1.118,7.124,P=0.029)。与西南地区相比,中西部地区的再入院风险降低了近 67%(OR=0.334,95% CI 0.134,0.813,p=0.016),东南部地区与西南地区相当:我们的研究发现,术后 AVP 缺乏、合并疾病较多和地理位置是垂体手术后 30 天再入院的风险因素。我们还需要进一步研究,以确定在同一医疗机构的其他地点如何采用特定地点的护理流程来降低再入院风险。
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来源期刊
Endocrine Practice
Endocrine Practice ENDOCRINOLOGY & METABOLISM-
CiteScore
7.60
自引率
2.40%
发文量
546
审稿时长
41 days
期刊介绍: Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.
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