Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
J Am Coll Surg. 2012 Nov;215(5):607-15. doi: 10.1016/j.jamcollsurg.2012.07.007. Epub 2012 Aug 24.
The incidence and associated risk factors for readmission after hepato-pancreato-biliary surgery are poorly characterized. The objective of the current study was to compare readmission after pancreatic vs hepatobiliary surgical procedures, as well as to identify potential factors associated with higher readmission within 30 days of discharge.
Using Surveillance, Epidemiology and End Results-Medicare linked data from 1986-2005, we identified 9,957 individuals aged 66 years and older who underwent complex hepatic, biliary, or pancreatic procedures for cancer treatment and were eligible for analysis. In-hospital morbidity, mortality, and 30-day readmission were examined.
Primary surgical treatment consisted of a pancreatic (46.7%), hepatic (50.0%), or biliary (3.4%) procedure. Mean patient age was 72.6 years and most patients were male (53.2%). The number of patients with multiple preoperative comorbidities increased over time (patients with Elixhauser's comorbidity score >13: 1986-1990, 47.0% vs 2001-2005, 62.9%; p < 0.001). Pancreatic operations had higher inpatient mortality vs hepatobiliary procedures (9.2% vs 7.3%; p < 0.001). Mean length of stay after pancreatic procedures was longer compared with hepatobiliary procedures (19.7 vs 10.3 days; p < 0.001). The proportion of patients readmitted after a pancreatic (1986-1990, 17.7%; 1991-1995, 16.1%; 1996-2000, 18.6%; 2001-2005, 19.6%; p = 0.15) or hepatobiliary (1986-1990, 14.3%; 1991-1995, 14.1%; 1996-2000, 15.2%; 2001-2005, 15.5%; p = 0.69) procedure did not change over time. Factors associated with increased risk of readmission included preoperative Elixhauser comorbidities >13 (odds ratio = 1.90) and prolonged index hospital stay ≥10 days (odds ratio = 1.54; both p < 0.05). During the readmission, additional morbidity and mortality were 46.5% and 8.0%, respectively.
Although the incidence of readmission did not change across the time periods examined, readmission was higher among patients undergoing a pancreatic procedure vs a hepatobiliary procedure. Other factors associated with risk of readmission included number of patient comorbidities and prolonged hospital stay. Readmission was associated with additional short-term morbidity and mortality.
肝胰胆手术后再入院的发生率和相关风险因素描述不足。本研究的目的是比较胰腺与肝胆手术的再入院情况，并确定出院后 30 天内再入院的潜在相关因素。
利用 1986 年至 2005 年期间监测、流行病学和最终结果-医疗保险相关数据，我们确定了 9957 名年龄在 66 岁及以上的个体，他们因癌症治疗接受了复杂的肝、胆或胰腺手术，有资格进行分析。检查了住院期间的发病率、死亡率和 30 天再入院率。
主要手术治疗包括胰腺（46.7%）、肝脏（50.0%）或胆道（3.4%）手术。患者平均年龄为 72.6 岁，大多数为男性（53.2%）。术前合并症较多的患者人数随时间增加（Elixhauser 合并症评分>13 的患者：1986-1990 年为 47.0%，2001-2005 年为 62.9%；p<0.001）。胰腺手术的住院死亡率高于肝胆手术（9.2% vs 7.3%；p<0.001）。与肝胆手术相比，胰腺手术后的平均住院时间更长（19.7 天 vs 10.3 天；p<0.001）。胰腺手术后（1986-1990 年，17.7%；1991-1995 年，16.1%；1996-2000 年，18.6%；2001-2005 年，19.6%；p=0.15）或肝胆手术后（1986-1990 年，14.3%；1991-1995 年，14.1%；1996-2000 年，15.2%；2001-2005 年，15.5%；p=0.69）再入院的比例并未随时间而改变。与再入院风险增加相关的因素包括术前 Elixhauser 合并症>13（比值比=1.90）和住院时间延长≥10 天（比值比=1.54；均 p<0.05）。在再入院期间，额外的发病率和死亡率分别为 46.5%和 8.0%。
尽管研究期间再入院的发生率没有变化，但与肝胆手术相比，胰腺手术后的再入院率更高。其他与再入院风险相关的因素包括患者合并症的数量和住院时间延长。再入院与短期额外的发病率和死亡率有关。
