Department of Surgery and Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Am Coll Surg. 2012 Apr;214(4):390-8; discussion 398-9. doi: 10.1016/j.jamcollsurg.2011.12.025. Epub 2012 Jan 29.
Data on readmission as well as the potential impact of length of stay (LOS) after colectomy for colon cancer remain poorly defined. The objective of the current study was to evaluate risk factors associated with readmission among a nationwide cohort of patients after colorectal surgery.
We identified 149,622 unique individuals from the Surveillance, Epidemiology, and End Results-Medicare dataset with a diagnosis of primary colorectal cancer who underwent colectomy between 1986 and 2005. In-hospital morbidity, mortality, LOS, and 30-day readmission were examined using univariate and multivariate logistic regression models.
Primary surgical treatment consisted of right (37.4%), transverse (4.9%), left (10.5%), sigmoid (22.8%), abdominoperineal resection (7.3%), low anterior resection (5.6%), total colectomy (1.2%), or other/unspecified (10.3%). Mean patient age was 76.5 years and more patients were female (52.9%). The number of patients with multiple preoperative comorbidities increased over time (Charlson comorbidity score ≥3: 1986 to 1990, 52.5% vs 2001 to 2005, 63.1%; p < 0.001). Mean LOS was 11.7 days and morbidity and mortality were 36.5% and 4.2%, respectively. LOS decreased over time (1986 to 1990, 14.0 days; 1991 to 1995, 12.0 days; 1996 to 2000, 10.4 days; 2001 to 2005, 10.6 days; p < 0.001). In contrast, 30-day readmission rates increased (1986 to 1990, 10.2%; 1991 to 1995, 10.9%; 1996 to 2000, 12.4%; 2001 to 2005, 13.7%; p < 0.001). Factors associated with increased risk of readmission included LOS (odds ratio = 1.02), Charlson comorbidities ≥3 (odds ratio = 1.27), and postoperative complications (odds ratio = 1.17) (all p < 0.01).
Readmission rates after colectomies have increased during the past 2 decades and mean LOS after this operation has declined. More research is needed to understand the balance and possible trade off between these hospital performance measures for all surgical procedures.
关于结肠切除术患者的再入院率以及住院时间（LOS）的潜在影响的数据仍不明确。本研究的目的是评估全国范围内接受结直肠手术后患者再入院的相关风险因素。
我们从 1986 年至 2005 年期间接受结肠切除术的原发性结直肠癌 Surveillance, Epidemiology, and End Results-Medicare 数据集的 149,622 个唯一个体中确定了 149,622 个个体。使用单变量和多变量逻辑回归模型检查住院期间发病率、死亡率、 LOS 和 30 天再入院率。
主要手术治疗包括右半结肠切除术（37.4%）、横结肠切除术（4.9%）、左半结肠切除术（10.5%）、乙状结肠切除术（22.8%）、腹会阴联合切除术（7.3%）、低位前切除术（5.6%）、全结肠切除术（1.2%）或其他/未指定（10.3%）。患者平均年龄为 76.5 岁，女性患者更多（52.9%）。术前合并症较多的患者数量随着时间的推移而增加（Charlson 合并症评分≥3：1986 年至 1990 年为 52.5%，2001 年至 2005 年为 63.1%；p<0.001）。平均 LOS 为 11.7 天，发病率和死亡率分别为 36.5%和 4.2%。LOS 随时间缩短（1986 年至 1990 年，14.0 天；1991 年至 1995 年，12.0 天；1996 年至 2000 年，10.4 天；2001 年至 2005 年，10.6 天；p<0.001）。相比之下，30 天再入院率增加（1986 年至 1990 年，10.2%；1991 年至 1995 年，10.9%；1996 年至 2000 年，12.4%；2001 年至 2005 年，13.7%；p<0.001）。与再入院风险增加相关的因素包括 LOS（优势比=1.02）、Charlson 合并症≥3（优势比=1.27）和术后并发症（优势比=1.17）（均 p<0.01）。
在过去 20 年中，结肠切除术的再入院率有所增加，并且该手术后的平均 LOS 有所下降。需要进一步研究以了解所有手术程序的这些医院绩效指标之间的平衡和可能的权衡。
