Study On Status And Influencing Factore Of Unplanned Readmission In Colorectal Cancer Patients With Stoma

Objective:The purpose of this study was to evaluate the prevalence of Unplanned Readmission(UP)of stoma patients with colorectal cancer,and to explore the relevant influencing factors that can affect unplanned readmission.We attempt to put forward the correspond nursing intervention measures,and provide reference basis for the continuous nursing of stoma patients.Methods:1.This study is a Nested Case-Control study.316 patients with colostomy was selected,and the patients who underwent colorectal cancer ostomy in three third-level hospitals in Henan Province from July 2018 to April 2019 as the research object,the patients who was followed up for 6 months.To observe whether UP occurred after discharge.The General Information Questionnaire,Quality of Discharge Teaching Scale(QDTS),Family Care-giving Competence Scale(FCCS),Ostomy Adjustment Inventory-20(OAI-20),Stoma Self-Efficacy Scale(SSES)was used to investigate colorectal cancer stoma patients.2.Software of Epi Data3.1 was used to establish the database,and SPSS 22.0 was applied to make statistical analyses.Mean,Standard deviation and Percentage was used to descriptive the statistics.Univariate analyses,including descriptive analysis,t-test Chi-square test,rank test,and multivariate logistic regression was used to analyze the impact of UP.Statistical significance is at the test level of P <0.05.Results:1.Current descriptionThe average age of 307 colorectal cancer ostomy patients was 57.04 ± 9.34 years old,including 169 female cases(55.0%),138 male cases(45%).The majority of participants were married(77.9%),in-service status(62.5%),had a family income of less than 2000 RMB/month(44.6%),had a senior high school/technical secondary school(44.3%).In terms of disease,a large proportion of patients with ileostomy(66.4%),the majority of participants has basic understanding of stoma(84.0%).The proportions of first hospitalization in 10?21 days,comorbidities were 77.9%,19.5%.2.Occurrence of UP in colorectal cancer patients with stoma78 patients had UP,the occurrence of UP was 25.4% within 6 months after colostomy.And the readmission occurred mostly within 3 months after discharge.3.The univariate analysis of influencing factors of UP risk in colorectal cancer patients with stomaTo identify demographic,clinical factors,QDTS,FCCS,OAI-20 and SSES associated with UP,we first compared patients with versus without UP in univariate analyses.The results indicate that marital status,educational level,occupation type,BMI,living conditions,average monthly income,number of first hospital stays,degree of stoma understanding,type of stoma,QDTS,FCCS,OAI-20,SSES was statistically significant(P<0.05).4.The logistic regression analysis of influencing factors of UP in colorectal cancer patients with stomaThe stoma patient's UP as the dependent variable,the independent variable was a single-factor statistically significant(P <0.05)variable,etc.A number of independent predictors of UP were revealed in multivariate logistic regression analyses.The results show that type of stoma,BMI,number of first hospital stays,QDTS,FCCS and SSES were the influencing factors of UP,can explain 56.8% of total variation.Patients with Ileostomy had a higher incidence of readmission(B = 1.672,OR = 5.324,P<0.001).BMI index of obesity(B = 1.171,OR = 3.226,P = 0.008)are more likely to have UP.The number of days of first hospitalization is a protective factor for unplanned readmissions.Patients with first hospitalization days<10 days(B = 1.061,OR = 2.890,P = 0.001)are at higher risk of UP.Patient discharge guidance quality,home care ability,and stoma self-efficacy level were negatively correlated with UP.In QDTS,more contents actually obtained(B = 0.291,OR=0.748,P<0.001),the better Guidance skills and good results(B = 0.215,OR = 0.807,P <0.001),the higher cognitive ability in family care(B = 1.325,OR = 0.266,P = 0.041)and high efficiency of stoma(B = 0.214,OR = 0.807,P = 0.035),which had a lower risk of UP.Conclusions:1.The incidence of UP in patients with colorectal cancer stoma was 25.4% within 6 months after surgery,which also occurred mostly within 3 months after discharge.2.The type of stoma,BMI,and the number of days of first hospitalization are independent influencing factors for UP in patients with stoma.Higher discharge teaching quality,family care-giving,and self-efficacy can reduce the incidence of readmissions.Enhance the discharge discharge guidance skills and effects,family care-giving ability of cognizance,and ostomy care effectiveness can be considered integral parts of interventions to reduce UP for colorectal cancer patients with stoma.