| Objective:to analyze the main causes and risk factors of unplanned readmission within 30 days after discharge of orthopedic surgery patients,and to provide solutions to reduce the rate of unplanned readmission.Methods : from January 2014 to December 2017,35423 cases of orthopedic surgery patients were collected in Orthopaedic Hospital,the First Affiliated Hospital of Nanchang University.Among them,56 cases of unplanned readmission within 30 days after discharge were the experimental group,and 134 cases of non-readmission patients were randomly selected as the control group.The collected case data included: family name,age,gender,ward,first admission diagnosis,basic diseases(hypertension,diabetes Anemia,hypoproteinemia),name and grade of the first operation,ASA score,whether to implant internal fixation,postoperative hospitalization days,first hospitalization days,discharge days,rehospitalization diagnosis,rehospitalization hospitalization days,rehospitalization treatment,retrospective analysis and summary of the reasons for rehospitalization of patients,reasons for rehospitalization in different areas,different discharge conditions The reasons for the time of readmission and the risk factors of unplanned readmission were analyzed.Results:a total of 56 orthopedic patients were admitted to the hospital 30 days after discharge.The readmission rate was 0.15%.The reasons for readmission were:infection of operation site(35 cases,62.5%),dislocation of artificial hip joint(3 cases,5.4%),fracture caused by fall of patients themselves(3 cases,5.4%),neurological dysfunction(3 cases,5.4%),wound pain(3 cases,5.4%),limb function 3 cases(5.4%),flap necrosis(2 cases,3.6%),missed diagnosis(1 case,1.8%),pressure sores(1 case,1.8%),postoperative joint stiffness(1 case,1.8%),cerebrospinal fluid leakage(1 case,1.8%),loosening of external fixator(1 case,1.8%).The primary cause of readmission in trauma area(24 cases,42.9%),spine area(17 cases,30.3%),hand display area(7 cases,12.5%)was surgical site infection;the primary cause ofreadmission in joint area(8 cases,14.3%)was artificial hip dislocation.The main reason for readmission in different time periods(1-10 days,11-20 days,21-30 days)after discharge was surgical site infection.27 cases were reoperated after readmission,the reoperation rate was 48.2%.Univariate analysis showed that age,smoking history,drinking history,implant fixation or not,ASA grade were not related to readmission(P > 0.05);gender,basic diseases(diabetes,hypertension,anemia,hypoproteinemia),operation grade,hospitalization days,postoperative hospitalization days were related to readmission(P < 0.05).Multivariate logistic regression analysis showed that gender,diabetes,hypertension and operation grade(grade 3)were independent risk factors for unplanned readmission within 30 days(P<0.05).Conclusion:the unplanned readmission rate of orthopedic patients within 30 days is 0.15%(56 / 35423),and surgical site infection is the primary cause of readmission.The main reason for the re admission of patients in trauma,spine and hand display areas is the infection of operation site,and the main reason for the re admission of patients in joint disease areas is the dislocation of artificial hip joint.The reason of re-entry in different time after discharge was surgical site infection.Gender,diabetes mellitus,hypertension and operation grade(grade 3)were independent risk factors for unplanned readmission within 30 days. |
