In elderly women, discharge after gynecologic surgery is often associated with increased morbidity. Little information exists about elderly women's discharge destination after gynecologic surgery and the outcome of early hospital readmission. The purpose of this study, conceptualized using the quality health outcomes model, was to examine whether post hysterectomy discharge destination is an independent predictor of 30-day hospital readmission in women age 65 and older. Examination of covariates included patient age, race, medical comorbidity and complications of care, as well as surgical anatomic approach and operative technique. This study involved use of a retrospective cohort design and data from 10,598 cases contained in the Healthcare Cost and Utilization Project 2010 and 2011 California State Inpatient Databases. Results of the bivariate analysis showed a statistically significant association between discharge destination after hysterectomy and 30-day hospital readmission. Additionally, the results of multivariate logistic regression revealed the odds of readmission after discharge with home care were 2.99, p < .001, 95% CI [2.29, 3.67] times greater when compared with discharge home for self-care and 5.99, p < .001, 95% CI [4.68, 7.43] times greater with discharge to continuing inpatient care versus home for self-care. This study may lead to positive social change for elderly women by informing health care providers about the odds of early hospital readmission associated with discharge destination after hysterectomy. Further, this information may stimulate development of interventions to improve health care practices for elderly women preparing for hospital discharge after hysterectomy.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第24844号 / 社医博第133号 / 新制||社医||13(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 近藤, 尚己, 教授 川上, 浩司, 教授 平井, 豊博 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM