Readmission To Intensive Care Units After Hepatobiliary-pancreatic Surgery:Risk Factors And Prediction

ObjectiveTo explore the reasons and risk factors related to surgical intensive care unit(SICU)readmission for patients who underwent hepatobiliary-pancreatic surgery,then to develop a predictive model,which was used to reduce patient mortality and the incidence of unplanned return to SICU,for determining patients who were likely to be readmitted to SICUs.MethodsA retrospective cohort study was conducted with the consecutive patients who were admitted to the SICU of the Affiliated Hospital of Qingdao University from January 1,2013 to August 31,2018.The unplanned SICU readmission within 3 days and within 7days are analyzed respectively,as well as the reasons of readmission.The patients group readmitted within 7 days was named as the readmitted group,and the non-readmitted cases was matched to readmitted cases according to 1:1 as a control group.A total of 38 indicators were divided into four categories,including general clinical data,medical history of patient,surgical indicators,and indicators on the day of discharge from the SICU.The indicators of the readmitted group and the non-readmitted group were statistically described,and to compare whether the difference between the two groups were statistically significance.Lasso regression was used to investigate the variables,and the selected variables were used to establish a logistic regression model.Finally,the discriminative ability and accuracy of the model were evaluated.The data were analyzed by R software in this study,and all were considered statistically significant at P < 0.05.ResultsOf the 763 patients discharged from the SICU alive,16(2.10%)were readmitted in 3days and 25(3.28%)were readmitted in 7 days to the SICU unexpectedly.The causes of SICU readmission in 7 days including infection(56.00%),heart failure(16.00%),infarction(12.00%),bleeding(12.00%),and sutures splitting(4.00%).The causes of SICU readmission in 3 days including infection(56.25%),heart failure(18.75%),infarction(12.50%),and bleeding(12.50%).Using nomogram analysis,the factors associated with unplanned SICU readmission were staying time in SICU,history of hypertension,ADL score,and white blood cell count,prothrombin time,fibrinogen,arterial partial pressure of oxygen on the day of SICU discharge.The clinical prediction model had robust discrimination and calibration.The C-index of the nomogram for prediction was 0.962(95% CI,0.869 to 1.057).ConclusionThe common causes of SICU readmission for patients who underwent hepatobiliary-pancreatic surgery were infection,heart failure,infarction and bleeding.Risk factors of readmission after SICU discharge include staying time in SICU,history of hypertension,ADL score,and white blood cell count,prothrombin time,fibrinogen,arterial partial pressure of oxygen on the day of SICU discharge.The model showed good performance in predicting the probability of readmission after SICU discharge.