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Patterns of hospital utilization after elective minimally invasive foregut surgery.
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2019-07-12 , DOI: 10.1007/s00464-019-06953-1
Anahita D Jalilvand 1 , Monet McNally 1 , Patricia Belle 1 , Kyle A Perry 1
Affiliation  

INTRODUCTION Post-operative non-urgent hospital visits (NUR-HV) are an important quality target for reducing unnecessary healthcare utilization. The primary objective of this study was to characterize 90-day post-operative hospital use and determine independent predictors for NUR-HV and urgent (UR)-HV after elective laparoscopic paraesophageal hernia repair (LPEHR) and Nissen Fundoplication (LNF). METHODS Five hundred and sixty-two primary LPEHR and LNF patients were retrospectively reviewed at a single institution. Ninety-day NUR-HV and UR-HV were compared to patients without post-operative HV using baseline medical and demographic data, preoperative work-up (manometry, pH testing, disease-specific quality of life and symptom scale scores (GERSS), and hospital course. Multiple logistic models were created using univariate associations (p < 0.1) to model independent predictors of NUR-HV and UR-HV. RESULTS NUR-HV accounted for 52% (n = 30) of all 90-HV, while the remaining were UR-HV (n = 28, 48.3%). Compared to controls, NUR-HV were younger (51.2 ± 16.8 years vs. 57.6 ± 15.2, p = 0.05), had a lower baseline BMI (28.2 ± 6.4 vs. 31.3 ± 5.4, p = 0.003) and ASA scores (p = 0.02), presented with higher GERSS (46 (28-60) vs. 35 (19-48), p = 0.02) and dysphagia scores (3 (1-5) vs. 2 (0-4), p = 0.02), were associated with LNF (77.7% vs. 54.6%, p = 0.02), and experienced more post-operative dysphagia (13.3% vs. 4.6%, p = 0.06). UR-HV were older (64.0 ± 13.2 vs. 57.6 ± 15.2, p = 0.03), associated with LPEHR (67.9% vs. 45.4%, p = 0.02), longer hospital stay (2 (1-3) vs. 1 (1-2), p = 0.003), and increased overall (39.3% vs. 15.1%, p = 0.001) and urgent complications (34.6% vs. 8.3%, p < 0.005). Positive predictors of NUR-HV included ASA score < 3 (OR 4.4, p = 0.02), increasing GERSS (1.04, p = 0.01), and reduced peristalsis (OR 4.7, p = 0.01), while UR-HV were independently predicted by urgent complications (5.0, p < 0.00005). CONCLUSIONS NUR-HV accounted for half of post-operative visits following LNF/LPEHR and were predicted by distinct characteristics compared to UR-HV. This stratification provides novel insight that will guide both preoperative counseling and post-operative quality initiatives.

中文翻译:

选择性微创前肠手术后医院利用的模式。

简介术后非紧急医院就诊(NUR-HV)是减少不必要的医疗保健使用的重要质量目标。这项研究的主要目的是表征术后90天的医院使用情况,并确定选择性腹腔镜食管旁疝修补术(LPEHR)和尼森胃底折叠术(LNF)后NUR-HV和紧急(UR)-HV的独立预测因子。方法回顾性回顾了562例原发性LPEHR和LNF患者。使用基线医学和人口统计学数据,术前检查(测压,pH测试,特定疾病的生活质量和症状量表评分(GERSS)),将90天的NUR-HV和UR-HV与没有术后HV的患者进行比较。和医院课程。使用单变量关联创建了多个逻辑模型(p <0。1)对NUR-HV和UR-HV的独立预测变量建模。结果NUR-HV占所有90-HV的52%(n = 30),其余为UR-HV(n = 28,48.3%)。与对照组相比,NUR-HV年轻(51.2±16.8岁vs. 57.6±15.2,p = 0.05),基线BMI较低(28.2±6.4 vs. 31.3±5.4,p = 0.003)和ASA评分(p = 0.02),更高的GERSS(46(28-60)vs.35(19-48),p = 0.02)和吞咽困难评分(3(1-5)vs 2(0-4),p = 0.02) ,与LNF相关(77.7%vs. 54.6%,p = 0.02),并且术后吞咽困难更多(13.3%vs. 4.6%,p = 0.06)。UR-HV年龄较大(64.0±13.2 vs. 57.6±15.2,p = 0.03),与LPEHR相关(67.9%vs. 45.4%,p = 0.02),住院时间更长(2(1-3)vs. 1( 1-2),p = 0.003),总体增加(39.3%vs. 15.1%,p = 0.001)和紧急并发症(34.6%vs. 8.3%,p <0.005)。NUR-HV的阳性预测指标包括ASA评分<3(OR 4.4,p = 0.02),GERSS增加(1.04,p = 0.01)和蠕动降低(OR 4.7,p = 0.01),而UR-HV由紧急并发症(5.0,p <0.00005)。结论NUR-HV占LNF / LPEHR术后访视的一半,与UR-HV相比,其独特特征可以预测。这种分层提供了新颖的见解,将指导术前咨询和术后质量倡议。结论NUR-HV占LNF / LPEHR术后访视的一半,与UR-HV相比,其独特特征可以预测。这种分层提供了新颖的见解,将指导术前咨询和术后质量倡议。结论NUR-HV占LNF / LPEHR术后访视的一半,与UR-HV相比,其独特特征可以预测。这种分层提供了新颖的见解,将指导术前咨询和术后质量倡议。
更新日期:2020-04-22
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