Association of Postdischarge Complications With Reoperation and Mortality in General Surgery

作者：Kazaure Hadiza S; Roman Sanziana A; Sosa Julie A^*

来源：Archives of Surgery, 2012, 147(11): 1000-1007.

DOI：10.1001/2013.jamasurg.114

Objectives: To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures.
Design: Retrospective cohort study.
Setting: American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files.
Patients: A total of 551 510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting.
Main Outcome Measures: Postdischarge complications, reoperation, and mortality.
Results: Of 551 510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use.
Conclusions: The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes. Arch Surg. 2012;147(11):1000-1007

• 出版日期2012-11