听...... 对本杰明·布鲁克的采访.
SALT LAKE CITY - Up to 22 percent of surgical patients experience unexpected complications and must be readmitted for post-operative care. A study led by the University of Utah suggests that returning to the same hospital is important for recovery. Readmission to a different hospital was associated with a 26 percent increased risk for dying within 90 days.
研究结果发表在 《大发娱乐》, have implications for patients who take part in domestic medical tourism programs.
Some of the nation's largest businesses encourage employees to travel to large U.S. medical centers for complex elective surgical procedures. As part of these medical travel programs, companies negotiate lower prices for patients to receive high-quality surgical care at some of the nation's premier hospitals.
But many participants must travel long distances – sometimes hundreds of miles from home – to reach destination hospitals, meaning it can be difficult to return should complications arise.
这不是一个小问题. Between 5 to 22 percent of patients were readmitted in our study, 这取决于手术的类型,第一作者说 本杰明·布鲁克，M.D., Ph.D., an assistant professor of 手术 at the University of Utah School of Medicine. "Our work suggests that striving to maintain continuity of care in the same hospital, and by the same medical team when possible, is critical to achieve the best outcomes should complications arise after 手术.
Returning to the site where the original operation was done was associated with improved survival regardless of whether it was a large teaching hospital or smaller community hospital. 病人 fared slightly better when also treated by the same surgical team. The trends held true for patients who underwent a wide range of common operations including neuro手术, 冠状动脉搭桥术和疝修补术.
Brooke recommends having operations done close to home when possible. Or if traveling to a destination hospital, planning to stay in the area during recovery. He adds that if a patient is readmitted to an outside hospital, "every effort should be made to transfer surgical patients back within 24 hours to their original hospital for post-operative management."
研究人员检查了9年的数据,440,503 Medicare patients who were readmitted within 30 days after undergoing any of 12 major surgical procedures between 2001 and 2011, the largest analysis of surgical patients of its kind. 66 to 83 percent of patients who had complications were readmitted to the same hospital. Statistical analyses demonstrated that these patients were more likely to survive 90 days after readmission than those who received post-operative treatment at a different hospital.
The trend was consistent across all surgeries, and ranged from a 44 percent decrease in risk for death for those who underwent pancreatectomy, to 13 percent for coronary artery bypass 手术, 根据风险调整, 逆概率加权模型. 第二种统计方法, 工具变量分析, showed attenuated results but supported the findings from these models. Because the results are observational in nature, a randomized trial is needed to prove a causal link.
The current results add to mounting evidence that continuity of care leads to better outcomes for a variety of acute and chronic medical conditions. The reports support the notion that returning to the same hospital may be more important than other measures of health care quality such as being treated at large medical centers that perform high volumes of specific procedures.
资深作者 Sam Finlayson， M.D.英里每小时, says even though the current study examined patients of retirement age, 它值得任何人考虑, 不管他们有多大.
"Most people do not think about the implications of traveling far for an operation,芬雷森说, 也是外科教授兼主席. "As with many health care decisions, there are trade-offs to consider. Traveling may confer the best chance of a favorable outcome with 手术, but it may hinder access to optimal care in the event of a serious complication after discharge."
"The interesting questions that our results raise are why outcomes appear to be better when a patient returns to the hospital where her or his operation was performed,他说. "Discovering the answers could help improve the way we deliver care."
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该作品发表于 "Readmission destination and risk of mortality after major 手术: an observational cohort study" online on June 18, 2015 in 《大发娱乐》
除了布鲁克和芬莱森, the authors are Larry Kraiss and Matthew Samore from the University of Utah School of Medicine, Philip Goodney from Dartmouth-Hitchcock Medical Center, and Daniel Gottlieb from The Dartmouth Institute for Health Policy and Clinical Practice
《大发娱乐》 also published a commentary on the research article, "Hospital readmission after 手术: no place like home"