[1]贺 田,沈鸣雁,方 丹,等.肝移植患者非计划性再入院发生率及影响因素的Meta分析[J].医学信息,2025,38(04):29-36.[doi:10.3969/j.issn.1006-1959.2025.04.005]
 HE Tian,SHEN Mingyan,FANG Dan,et al.Meta-analysis of the Incidence and Influencing Factors of Unplanned Readmission in Patients Undergoing Liver Transplantation[J].Journal of Medical Information,2025,38(04):29-36.[doi:10.3969/j.issn.1006-1959.2025.04.005]
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肝移植患者非计划性再入院发生率及影响因素的Meta分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
38卷
期数:
2025年04期
页码:
29-36
栏目:
医学数据科学
出版日期:
2025-02-15

文章信息/Info

Title:
Meta-analysis of the Incidence and Influencing Factors of Unplanned Readmission in Patients Undergoing Liver Transplantation
文章编号:
1006-1959(2025)04-0029-08
作者:
贺 田1沈鸣雁1方 丹2贾欣宇1朱荣昌1
1.浙江树人学院,浙江 杭州 310000;2.南京中医药大学护理学院,江苏 南京 210000
Author(s):
HE Tian1 SHEN Mingyan1 FANG Dan2 JIA Xinyu1 ZHU Rongchang1
1.Zhejiang Shuren University, Hangzhou 310000, Zhejiang,China;2.School of Nursing, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu, China
关键词:
肝移植非计划性再入院影响因素病例对照研究队列研究Meta分析
Keywords:
Liver transplantation Unplanned readmission Influencing factors Case-control study Cohort study Meta-analysis
分类号:
R617
DOI:
10.3969/j.issn.1006-1959.2025.04.005
文献标志码:
A
摘要:
目的 探讨肝移植患者非计划性再入院的发生率及影响因素,为早期识别患者再入院提供依据。方法 计算机检索PubMed、Web of Science、Embase、The Cochrane Library、中国知网、万方、中国生物医学文献数据库、维普数据库发表的相关文献,检索时间均从建库至2023年9月23日。由两名研究者独立筛选文献、提取资料、对文献进行偏倚风险质量评价,采用Stata16软件进行Meta分析。结果 共纳入18篇文献,文献整体质量中等偏高,总样本量45 320例。肝移植患者非计划性再入院的发生率范围为10%~64%,合并发生率为38%(95%CI:0.34~0.43)。受者年龄[OR=1.04,95%CI(1.02,1.07),P<0.001]、感染[OR=1.32,95%CI(0.87,2.01),P=0.003]、合并糖尿病[OR=2.54,95%CI(1.46,4.42),P=0.001]、移植前透析[OR=1.83,95%CI(1.23,2.72),P=0.003]、移植指证(肝病病因)[OR=2.22,95%CI(1.68,2.92),P<0.001]、器官捐赠类型[OR=1.23,95%CI(1.01,1.50),P=0.036]、术后并发症[OR=1.34,95%CI(1.01,1.67),P=0.017]是肝移植患者非计划性再入院的危险因素,男性[OR=0.60,95%CI(0.44,0.83),P=0.002]、使用降低再入院方案[OR=0.34,95%CI(0.23,0.53),P<0.001]、周末出院[OR=0.41,95%CI(0.25,0.66),P<0.001]是肝移植患者非计划性再入院的保护因素。结论 受者年龄、感染、合并糖尿病、移植前透析、移植指征(肝病病因)、器官捐献类型、术后并发症、男性、使用降低再入院方案、周末出院与肝移植患者非计划性再入院密切相关。但本研究纳入文献为观察性研究,存在一定局限性,尚需开展更多大样本的前瞻性队列研究来进行验证。
Abstract:
Objective To investigate the incidence and influencing factors of unplanned readmission in patients undergoing liver transplantation, and to provide evidence for early identification of readmission. Methods The relevant literatures published in PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, Wanfang, Chinese Biomedical Literature Database and VIP Database were searched by computer. The retrieval time was from the establishment of the database to September 23, 2023. Two researchers independently screened the literature, extracted the data, and evaluated the quality of bias risk of the literature. Meta-analysis was performed using Stata16 software. Results A total of 18 articles were included, and the overall quality of the literature was moderately high, with a total sample size of 45 320 cases. The incidence of unplanned readmission in patients with liver transplantation ranged from 10% to 64%, and the combined incidence was 38%(95%CI: 0.34-0.43). Recipient age [OR=1.04, 95%CI (1.02, 1.07), P<0.001], infection [OR=1.32, 95%CI (0.87, 2.01), P=0.003], diabetes mellitus [OR=2.54, 95%CI (1.46, 4.42), P=0.001], dialysis before transplantation [OR=1.83, 95%CI (1.23, 2.72), P=0.003], transplantation indication (etiology of liver disease) [OR=2.22, 95%CI (1.68, 2.92)]. P<0.001], organ donation type [OR=1.23, 95%CI (1.01, 1.50), P=0.036], postoperative complications [OR=1.34, 95%CI (1.01, 1.67), P=0.017] were risk factors for unplanned readmission in patients with liver transplantation. Male [OR=0.60, 95%CI (0.44, 0.83), P=0.002], use of reduced readmission regimen [OR=0.34, 95%CI (0.23, 0.53). P<0.001] and discharge at weekends [OR=0.41, 95%CI (0.25, 0.66), P<0.001] were protective factors for unplanned readmission in liver transplant patients. Conclusion Recipient age, infection, diabetes mellitus, dialysis before transplantation, transplantation indication (etiology of liver disease), type of organ donation, postoperative complications, male, use of reduced readmission program, and discharge at weekends are closely related to unplanned readmission of liver transplant patients. However, the literature included in this study is observational research, which has certain limitations, and more large-sample prospective cohort studies are needed to verify it.

参考文献/References:

[1]Rana A,Ackah RL,Webb GJ,et al.No Gains in Long-term Survival After Liver Transplantation Over the Past Three Decades[J].Ann Surg,2019,269(1):20-27.[2]葛均波,徐永健,王辰.第9版内科学[M].北京:北京人民卫生出版社,2018.[3]牛玉坚,臧运金,陈新国,等.Ⅲ期或Ⅳa1期肝癌肝移植的生活质量和生存率[J].癌症进展,2007,5(1):94-98.[4]Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-605.[5]周英凤,顾莺,胡雁,等.JBI循证卫生保健中心对关于不同类型研究的质量评价工具——患病率及分析性横断面研究的质量评价[J].护士进修杂志,2018,33(3):219-221.[6]Shankar N,Marotta P,Wall W,et al.Defining readmission risk factors for liver transplantation recipients[J].Gastroenterol Hepatol (N Y),2011,7(9):585-590.[7]Pereira AA,Bhattacharya R,Carithers R,et al.Clinical factors predicting readmission after orthotopic liver transplantation[J].Liver Transpl,2012,18(9):1037-1045.[8]Paterno F,Wilson GC,Wima K,et al.Hospital utilization and consequences of readmissions after liver transplantation[J].Surgery,2014,156(4):871-878.[9]Nagaraja R,Mehta N,Kumaran V,et al.Readmission after living donor liver transplantation: predictors,causes,and outcomes[J].Indian J Gastroenterol,2014,33(4):369-374.[10]Chen P,Wang W,Yan L,et al.Risk factors for first-year hospital readmission after liver transplantation[J].Eur J Gastroenterol Hepatol,2015,27(5):600-606.[11]Wilson GC,Hoehn RS,Ertel AE,et al.Variation by center and economic burden of readmissions after liver transplantation[J].Liver Transpl,2015,21(7):953-960.[12]Rogal S,Mankaney G,Udawatta V,et al.Association between opioid use and readmission following liver transplantation[J].Clin Transplant,2016,30(10):1222-1229.[13]Kothari AN,Yau RM,Blackwell RH,et al.Inpatient Rehabilitation after Liver Transplantation Decreases Risk and Severity of 30-Day Readmissions[J].J Am Coll Surg,2016,223(1):164-171.[14]Patel MS,Mohebali J,Shah JA,et al.Readmission following liver transplantation: an unwanted occurrence but an opportunity to act[J].HPB (Oxford),2016,18(11):936-942.[15]Haddad L,Andrade K,Mendes L,et al.Association Between Readmission After Liver Transplant and Adverse Immunosuppressant Reactions: A Prospective Cohort With a 1-Year Follow-up[J].Transplant Proc,2017,49(2):330-337.[16]Russo MW,Levi DM,Pierce R,et al.A prospective study of a protocol that reduces readmission after liver transplantation[J].Liver Transpl,2016,22(6):765-772.[17]Oh SY,Lee JM,Lee H,et al.Emergency department visits and unanticipated readmissions after liver transplantation: A retrospective observational study[J].Sci Rep,2018,8(1):4084.[18]Zeidan JH,Levi DM,Pierce R,et al.Strategies That Reduce 90-Day Readmissions and Inpatient Costs After Liver Transplantation[J].Liver Transpl,2018,24(11):1561-1569.[19]Mahmud N,Halpern S,Farrell R,et al.An Advanced Practice Practitioner-Based Program to Reduce 30- and 90-Day Readmissions After Liver Transplantation[J].Liver Transpl,2019,25(6):901-910.[20]Mumtaz K,Lee-Allen J,Porter K,et al.Thirty-day readmission rates,trends and its impact on liver transplantation recipients: a national analysis[J].Sci Rep,2020,10(1):19254.[21]Dols JD,Chargualaf KA,Gordon A,et al.Relationship of Nurse-Led Education Interventions to Liver Transplant Early Readmission[J].Prog Transplant,2020,30(2):88-94.[22]Salah M,Montasser IF,El GH,et al.Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant: A single-centre retrospective cohort study[J].World J Hepatol,2022,14(6):1150-1161.[23]Molina AP,Citores SM,Arias MA,et al.Emergency department frequentation and unscheduled readmissions within the first year after liver transplantation,and their impact on survival[J].Rev Esp Enferm Dig,2022,114(5):266-271.[24]Gheorghe G,Diaconu CC,Bungau S,et al.Biliary and Vascular Complications after Liver Transplantation-From Diagnosis to Treatment[J].Medicina (Kaunas),2023,59(5):850.[25]Khan S,Chidi A,Hrebinko K,et al.Readmission After Surgical Resection and Transplantation for Hepatocellular Carcinoma: A Retrospective Cohort Study[J].Am Surg,2022,88(1):83-92.[26]Li AH,Lam NN,Naylor KL,et al.Early Hospital Readmissions After Transplantation: Burden, Causes, and Consequences[J].Transplantation,2016,100(4):713-718.[27]Fluck D,Murray P,Robin J,et al.Early emergency readmission frequency as an indicator of short-,medium- and long-term mortality post-discharge from hospital[J].Intern Emerg Med,2021,16(6):1497-1505.[28]Son YG,Lee H,Oh SY,et al.Risk Factors for Intensive Care Unit Readmission After Liver Transplantation: A Retrospective Cohort Study[J].Ann Transplant,2018,23:767-774.[29]Burra P,De Martin E,Gitto S,et al.Influence of age and gender before and after liver transplantation[J].Liver Transpl,2013,19(2):122-134.[30]Sacks GD,Hiatt JR.Weekday or Weekend Discharge-Does It Make a Difference?[J].JAMA Surg,2015,150(9):856-857.[31]Cigrovski BM,Virovic-Jukic L,Bilic-Curcic I,et al.Post-transplant diabetes mellitus and preexisting liver disease - a bidirectional relationship affecting treatment and management[J].World J Gastroenterol,2020,26(21):2740-2757.[32]Chang AL,Cortez AR,Bondoc A,et al.Metabolic syndrome in liver transplantation: A preoperative and postoperative concern[J].Surgery,2016,160(4):1111-1117.[33]吴小霞,吴灵俐,舒琳,等.肝移植术后革兰氏阳性球菌的感染特点及防治效果[J].中南大学学报(医学版),2023,48(5):707-715.[34]van Hoek B,de Rooij BJ,Verspaget HW.Risk factors for infection after liver transplantation[J].Best Pract Res Clin Gastroenterol,2012,26(1):61-72.[35]Daugaard TR,Pommergaard HC,Rostved AA,et al.Postoperative complications as a predictor for survival after liver transplantation - proposition of a prognostic score[J].HPB (Oxford),2018,20(9):815-822.[36]Xu Y,Li L,Evans M,et al.Burden and causes of hospital admissions and readmissions in patients undergoing hemodialysis and peritoneal dialysis: a nationwide study[J].J Nephrol,2021,34(6):1949-1959.[37]Sanabria M,Buitrago G,Lindholm B,et al.Remote Patient Monitoring Program in Automated Peritoneal Dialysis: Impact on Hospitalizations[J].Perit Dial Int,2019,39(5):472-478.[38]武睿超,黄兆宇,张黎,等.大鼠心脏死亡器官捐献供体原位肝移植模型建立的经验总结[J].器官移植,2018,9(4):304-310.[39]Chirapongsathorn S,Talwalkar JA,Kamath PS.Strategies to Reduce Hospital Readmissions[J].Semin Liver Dis,2016,36(2):161-166.[40]Kathiresu R,Zinat SN,Fernando M.Immune reconstitution inflammatory syndrome following Cryptococcal neoformans infection in an immunocompetent host: A case report and review of the literature[J].IDCases,2020,19:e699.

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更新日期/Last Update: 1900-01-01