| Objective:To explore the causes and risk factors of unplanned readmission within 30 days after discharge for patients with severed finger after replantation surgery,and to construct a histogram risk prediction model,so as to provide a theoretical basis for early screening of high-risk patients and optimizing clinical decision-making,so as to reduce the rate of unplanned readmission within 30 days.Methods: Clinical data of patients with complete amputated finger injury who underwent finger replantation in the Department of Hand Surgery of the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from September 2015 to February 2020 were retrospectively collected.A total of 1312 patients were included,and they were divided into UR group(27 cases)and control group(1285 cases)according to whether they were readmitted unplanned within 30 days after discharge.First,common causes of unplanned readmission within 30 days were analyzed,and 32 clinical indicators were collected for univariate analysis,and statistically significant clinical indicators were screened out(P < 0.05).Multivariate Logistic regression analysis was performed on the screened clinical indicators to determine independent risk factors for readmission.According to the independent risk factors for readmission risk prediction model was constructed and the model to make evaluation,and then the Hosmer-Lemeshow goodness-of-fit test,draw the area under the receiver-operating characteristic curve and calculate the area under the curve to evaluate the performance of the model,Finally,the visual nomogram of readmission is drawn by R language,and the concordance index is calculated and the correction chart is drawn to verify the nomogram.Results:There were 27 cases of unplanned readmission within 30 days after discharge.The readmission rate was 2.06%,including 9 female patients(37%)and 18 male patients(67%).The main causes of readmission included:finger infection(12 / 27),blood circulation disorder(4 / 27),finger necrosis(2 /27),skin necrosis(3 / 27),bone exposure(3 / 27),finger pain(2 / 27),residual internal fixation fracture(1 / 27).By univariate analysis of 32 clinical indexes,five significant indexes were screened out,including injury mechanism,ischemia duration of severed finger,thorough debridement,the proportion of digital arteriovenous anastomosis,and the level of microsurgery(P < 0.05).The results of multivariate logistic regression analysis were as follows:(1)the re admission risk of crush injury was 4.515 times of that of cutting injury(P =0.021,or = 4.515,95% CI = 1.257-16.22);the readmission risk of avulsion injury was 4.556 times of that of cutting injury(P = 0.021,or = 4.556,95% CI= 1.253-16.56).(2)The risk of readmission was 13.02 times higher in patients with warm ischemia duration > 12 h than in patients with warm ischemia duration ≤ 6h(P = 0.004,or = 13.02,95% CI = 2.286-74.14).(3)The re-entry risk of incomplete debridement was 3.749 times that of complete debridement(P = 0.017,or = 3.749,95% CI = 1.261-11.1).(4)The ratio of digital arteriovenous anastomosis(2:1)had the highest risk of readmission(P = 0.027,or = 15.66,95% CI = 1.371-178.8).(5)The re-entry risk of attending physicians was 72.6% lower than that of resident physicians(P = 0.026,or =0.274,95% CI = 0.088-0.858).The re-entry risk of deputy chief physicians and above was 77.9% lower than that of resident physicians(P = 0.013,or = 0.221,95% CI = 0.0067-0.729).The risk prediction model of readmission based on independent risk factors was N = logit(P)= 3.736 + * 1.516x1 + 2.566 * x2 +1.321 * X3 + 2.751 * x4-1.508 * X5.The goodness of fit(P = 0.454)was tested by Hosmer lemeshow method,and the area under the curve of the model was calculated to be 0.727.The goodness of fit and discrimination of the model were proved to be good.According to the model,the visual nomogram is drawn,and the calibration curve is obtained by calculating the concordance index =0.727 and bootstrap self sampling method,which also shows that the accuracy of the model is high.Conclusion:The most common cause of readmission within 30 days after discharge is finger body infection.Injury mechanism,thorough debridement,microsurgical skills of the operator,the proportion of digital arteriovenous anastomosis and the duration of ischemia were independent risk factors for readmission.The nomogram of clinical risk prediction model based on independent risk factors is simple,intuitive and practical.It can be used to predict high-risk patients who are readmitted.It has certain guiding significance for the clinical work of hand surgeons. |
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