Valero-Elizondo Javier, Kim Yuhree, Prescott Jason D, Margonis Georgios A, Tran Thuy B, Postlewait Lauren M, Maithel Shishir K, Wang Tracy S, Glenn Jason A, Hatzaras Ioannis, Shenoy Rivfka, Phay John E, Keplinger Kara, Fields Ryan C, Jin Linda X, Weber Sharon M, Salem Ahmed, Sicklick Jason K, Gad Shady, Yopp Adam C, Mansour John C, Duh Quan-Yang, Seiser Natalie, Solorzano Carmen C, Kiernan Colleen M, Votanopoulos Konstantinos I, Levine Edward A, Poultsides George A, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
J Gastrointest Surg. 2015 Dec;19(12):2154-61. doi: 10.1007/s11605-015-2917-x. Epub 2015 Aug 19.
Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis. Given the lack of data on readmission after resection of ACC, the objective of the current study was to define the incidence of readmission, as well as identify risk factors associated with readmission among patients with ACC who underwent surgical resection.
Two hundred nine patients who underwent resection of ACC between January 1993 and December 2014 at 1 of 13 major centers in the USA were identified. Demographic and clinicopathological data were collected and analyzed relative to readmission.
Median patient age was 52 years, and 62 % of the patients were female. Median tumor size was 12 cm, and the majority of patients had an American Society of Anesthesiologists (ASA) class of 3-4 (n = 85, 56 %). The overall incidence of readmission within 90 days from surgery was 18 % (n = 38). Factors associated with readmission included high ASA class (odds ratio (OR), 4.88 (95 % confidence interval (CI), 1.75-13.61); P = 0.002), metastatic disease on presentation (OR, 2.98 (95 % CI, 1.37-6.46); P = 0.006), EBL (>700 mL: OR, 2.75 (95 % CI, 1.16-6.51); P = 0.02), complication (OR, 1.91 (95 % CI, 1.20-3.05); P = 0.007), and prolonged length of stay (LOS; ≥9 days: OR, 4.12 (95 % CI, 1.88-9.01); P < 0.001). On multivariate logistic regression, a high ASA class (OR, 4.01 (95 % CI, 1.44-11.17); P = 0.008) and metastatic disease on presentation (OR, 3.44 (95 % CI, 1.34-8.84); P = 0.01) remained independently associated with higher odds of readmission.
Readmission following surgery for ACC was common as one in five patients experienced a readmission. Patients with a high ASA class and metastatic disease on presentation were over four and three times more likely to be readmitted after surgical treatment for ACC, respectively.
肾上腺皮质癌（ACC）是一种预后较差的罕见疾病。鉴于缺乏ACC切除术后再入院的数据，本研究的目的是确定再入院的发生率，并识别接受手术切除的ACC患者中与再入院相关的风险因素。
确定了1993年1月至2014年12月期间在美国13个主要中心之一接受ACC切除术的209例患者。收集并分析了与再入院相关的人口统计学和临床病理数据。
患者中位年龄为52岁，62%为女性。肿瘤中位大小为12 cm，大多数患者美国麻醉医师协会（ASA）分级为3 - 4级（n = 85，56%）。术后90天内再入院的总体发生率为18%（n = 38）。与再入院相关的因素包括高ASA分级（比值比（OR），4.88（95%置信区间（CI），1.75 - 13.61）；P = 0.002））、就诊时存在转移性疾病（OR，2.98（95% CI，1.37 - 6.46）；P = 0.006）、术中失血（EBL）>700 mL（OR，2.75（95% CI，1.16 - 6.51）；P = 0.02）、并发症（OR，1.91（95% CI，1.20 - 3.05）；P = 0.007）以及住院时间延长（LOS；≥9天：OR，4.12（95% CI，1.88 - 9.01）；P < 0.001）。在多因素逻辑回归分析中，高ASA分级（OR，4.01（95% CI，1.44 - 11.17）；P = 0.008）和就诊时存在转移性疾病（OR，3.44（95% CI，1.34 - 8.84）；P = 0.01）仍然独立地与再入院几率较高相关。
ACC手术后再入院情况很常见，五分之一的患者经历了再入院。高ASA分级和就诊时存在转移性疾病的患者在接受ACC手术治疗后再入院的可能性分别是其他患者的四倍多和三倍多。
