30-day unplanned readmission rate in otolaryngology patients: A population-based study in Thuringia, Germany


Autoři: Wido Rippe aff001;  Andreas Dittberner aff001;  Daniel Boeger aff002;  Jens Buentzel aff003;  Kerstin Hoffmann aff004;  Holger Kaftan aff005;  Andreas Mueller aff006;  Gerald Radtke aff007;  Orlando Guntinas-Lichius aff001
Působiště autorů: Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany aff001;  Department of Otorhinolaryngology, SRH Zentralklinikum, Suhl, Germany aff002;  Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany aff003;  Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany aff004;  Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany aff005;  Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany aff006;  Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224146

Souhrn

Purpose

Analyze associations between patients’ characteristics and treatment factors with 30-day unplanned readmissions in hospitalized otolaryngology patients in the German Diagnosis Related Group (D-DRG) system.

Methods

A retrospective cohort study was performed on 15.271 otolaryngology admissions of 12.859 patients in 2015 in Thuringia, Germany. The medical records of the 1173 cases (7.6%) with readmission within 30-days were analyzed in detail.

Results

The 30-day readmission was planned in 747 cases (4.9%) and was unplanned in 422 cases (2.8%). The median interval between primary and next inpatient treatment was 11 days. The principal diagnosis was the same as during the primary index treatment in 72% of the cases. The most frequent reasons for readmission were: Need for non-surgical therapy (31.2%), need for further surgery (26.3%), post-surgical complaints (16.9%), and recurrence of primary complaints (10.7%). The multivariate analysis revealed that discharge due to patient’s request against medical advice was a strong independent factor with high risk for unplanned readmission (Odds Ratio [OR] = 9.62]; confidence interval [CI] = 2.69–34.48). Surgery at index admission (OR = 3.33; CI = 1.86–5.96) was the second important independent risk factor for unplanned readmission. Unplanned readmission had more frequently a non-surgical treatment at readmission than a surgical treatment (OR = 3.92; CI = 2.24–6.84) and needed more frequently further diagnostics (OR = 2.34; CI = 1.34–4.11). The following index International Classification of Diseases (ICD) categories had the highest risk for unplanned readmission: Injury, poisoning and certain other consequences of external causes, ICD: S00-T98 (OR = 66.67; CI = 15.87–333.33), symptoms, signs, abnormal findings, ill-defined causes, not otherwise classified, ICD: R00-R99 (OR = 62.5; CI = 11.76–333.33), blood forming organ diseases, ICD: D50-D90 (OR = 21.276; CI = 3.508–125), and eye/ ear diseases, ICD: H00-H95 (OR = 12.66; CI = 4.29–37.03).

Conclusions

The causes of unplanned 30-day readmission in German otolaryngology inpatients are multifactorial. Specific patient and treatment characteristics were identified to be targeted with health care interventions to decrease unplanned readmissions.

Klíčová slova:

Diagnostic medicine – Drug therapy – Head and neck cancers – Inpatients – Otolaryngological procedures – Otorhinolaryngology – Surgical and invasive medical procedures – Surgical oncology


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 10