UNASSIGNED:慢性肾脏病与冠状动脉旁路移植术后不良结局之间的关联已确立,慢性肾脏病与再入院之间的关系研究较少.我们假设慢性肾病分期较高的患者有更大的再入院风险,较差的手术结果,和更大的住院费用。
UASSIGNED:使用2016-2018年全国再招生数据库,我们确定了519,387例接受单纯冠状动脉旁路移植术的患者.根据国际疾病分类第10次修订分类,按慢性肾脏病分期对患者进行分层。多变量logistic回归用于评估住院死亡率和90天再入院的危险因素。
未经批准:再次入院,住院死亡率,随着慢性肾脏病分期的恶化,费用逐渐增加;终末期肾脏病患者的住院死亡率最高(7.2%),住院费用(59,616美元)(P<.001),90天再入院率(40%)(P<.001)。慢性肾脏病分期大于3与住院死亡率相关(比值比,1.56,95%置信区间,1.40-1.73;P<.001)和90天再入院(赔率比,1.66,95%置信区间,1.56-1.76;P<.001)。出院后30天,与慢性肾病1~3患者(1.4%;n=8623)和无慢性肾病患者(0.3%;n=38,885)相比,慢性肾病4~5患者(8.9%;n=1495)的新发病透析依赖发生率更高.出院后90天,再次入院的慢性肾脏病4~5例患者的透析依赖增加至11.1%(n=1916),但慢性肾脏病1~3例患者(1.4%;n=10,907)和无慢性肾脏病患者(0.3%;n=50,200)的透析依赖保持稳定.
未经证实:慢性肾脏病分期与死亡率密切相关,新发透析依赖,重新接纳,冠状动脉旁路移植术后成本较高。慢性肾病4和5患者和终末期肾病患者的再入院率最高。虽然还需要进一步的研究,在慢性肾脏病患者的冠状动脉旁路移植术后,有针对性的治疗方法可能会降低代价高昂的再入院率并改善预后.
UNASSIGNED: The association between chronic kidney disease and adverse outcomes after coronary artery bypass grafting is well established; in contrast, the association between chronic kidney disease and readmission has been less thoroughly investigated. We hypothesized that patients at higher chronic kidney disease stages have greater risk of readmission, poorer operative outcomes, and greater hospitalization cost.
UNASSIGNED: Using the 2016-2018 Nationwide Readmissions Database, we identified 519,387 patients who underwent isolated coronary artery bypass grafting. Patients were stratified by chronic kidney disease stage based on International Classification of Diseases 10th Revision classification. Multivariable logistic regression was used to assess risk factors for in-hospital mortality and 90-day readmission.
UNASSIGNED: Hospital readmission, in-hospital mortality, and cost progressively increased with worsening chronic kidney disease stage; patients with end-stage renal disease had the highest in-hospital mortality rate (7.2%), hospitalization costs ($59,616) (P < .001), and 90-day readmission rate (40%) (P < .001). Chronic kidney disease stage greater than 3 was associated with in-hospital mortality (odds ratio, 1.56, 95% confidence interval, 1.40-1.73; P < .001) and 90-day readmission (odds ratio, 1.66, 95% confidence interval, 1.56-1.76; P < .001). At 30 days after discharge, new-onset dialysis dependence was more frequent in patients readmitted with chronic kidney disease 4 to 5 (8.9%; n = 1495) than in patients with chronic kidney disease 1 to 3 (1.4%; n = 8623) and patients without chronic kidney disease (0.3%; n = 38,885). At 90 days after discharge, dialysis dependence increased to 11.1% (n = 1916) in readmitted patients with chronic kidney disease 4 to 5 but remained stable for patients with chronic kidney disease 1 to 3 (1.4%; n = 10,907) and patients without chronic kidney disease (0.3%; n = 50,200).
UNASSIGNED: Chronic kidney disease stage is strongly associated with mortality, new-onset dialysis dependence, readmission, and higher cost after coronary artery bypass grafting. Patients with chronic kidney disease 4 and 5 and patients with end-stage renal disease are readmitted at the highest rates. Although further research is needed, a targeted approach may reduce costly readmissions and improve outcomes after coronary artery bypass grafting in patients with chronic kidney disease.