Kim Sooyeon, Maynard Erin C, Shah Malay B, Daily Michael F, Tzeng Ching-Wei D, Davenport Daniel L, Gedaly Roberto
Department of Surgery, Section of Transplant Surgery, University of Kentucky College of Medicine, 800 Rose Street, Room C453, Lexington, KY, 40508, USA.
J Gastrointest Surg. 2015 Feb;19(2):266-71. doi: 10.1007/s11605-014-2713-z. Epub 2014 Dec 2.
The aim of this study was to identify risk factors associated with unplanned readmissions after hepatectomies.
Patients who underwent hepatectomies between January and December of 2011 were identified using the ACS-NSQIP database. A multivariate logistic regression analysis was performed to determine predictors of unplanned readmissions related to the procedure within 30 days.
Unplanned readmissions occurred in 10.5 % of all patients who received a hepatectomy. On multivariate analysis, transfusion within 72 h after surgery (odds ratio [OR] 1.74, p < 0.001), complexity of procedure (extended, OR 1.84, p = 0.004; right hepatectomy, OR 1.66, p = 0.003), and longer operative time (>median 320 min, OR 2.43, p < 0.001) were independent perioperative predictors of unplanned readmissions. Independent preoperative risk factors included elevated alkaline phosphatase (OR 1.45, p = 0.017), bleeding disorders (OR 1.72, p = 0.051), and lower albumin levels (OR 1.30, p = 0.036).
Transfusion, complexity of procedure, and duration of operation were the strongest predictors of unplanned readmissions after liver resection.
本研究旨在确定肝切除术后计划外再入院的相关危险因素。
利用美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库识别2011年1月至12月期间接受肝切除术的患者。进行多因素逻辑回归分析以确定30天内与手术相关的计划外再入院的预测因素。
在所有接受肝切除术的患者中，10.5%发生了计划外再入院。多因素分析显示，术后72小时内输血（比值比[OR] 1.74，p < 0.001）、手术复杂性（扩大手术，OR 1.84，p = 0.004；右半肝切除术，OR 1.66，p = 0.003）以及较长的手术时间（>中位数320分钟，OR 2.43，p < 0.001）是计划外再入院的独立围手术期预测因素。术前独立危险因素包括碱性磷酸酶升高（OR 1.45，p = 0.017）、出血性疾病（OR 1.72，p = 0.051）以及较低的白蛋白水平（OR 1.30，p = 0.036）。
输血、手术复杂性和手术时长是肝切除术后计划外再入院的最强预测因素。
