Zhuang Cheng-Le, Wang Su-Lin, Huang Dong-Dong, Pang Wen-Yang, Lou Neng, Chen Bi-Cheng, Chen Xiao-Lei, Yu Zhen, Shen Xian
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Wenzhou Key Laboratory of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
PLoS One. 2015 Apr 27;10(4):e0125572. doi: 10.1371/journal.pone.0125572. eCollection 2015.
Hospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.
We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined.
A total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition.
Readmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.
作为衡量医疗质量的一项指标以及潜在的成本节约目标，医院再入院正日益受到关注。本前瞻性研究的目的是确定胃癌患者胃切除术后30天内再入院的危险因素。
我们对2013年10月至2014年11月在我院接受胃癌根治性胃切除术的患者进行了一项前瞻性研究。确定了30天再入院的发生率、原因和危险因素。
共有376例患者纳入我们的分析，随访无失访。胃癌根治性胃切除术后30天再入院率为7.2%（376例中的27例）。再入院的最常见原因包括胃肠道并发症和术后感染。基于多因素logistic回归分析，术前营养风险筛查2002评分≥3是30天再入院的独立危险因素。与较高再入院率无关的因素包括本次住院期间有重大术后并发症史、术后初次住院时间延长、既往腹部手术史、高龄、体重指数、术前存在心肺合并症、美国麻醉医师协会分级、切除类型、淋巴结清扫范围和出院处置情况。
胃癌根治性胃切除术后30天内再入院很常见。术前有营养风险的患者30天再入院风险高。对有营养风险的患者术前优化营养状况可有效降低再入院率。
