Puri Varun, Patel Aalok P, Crabtree Traves D, Bell Jennifer M, Broderick Stephen R, Kreisel Daniel, Krupnick A Sasha, Patterson G Alexander, Meyers Bryan F
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
J Thorac Cardiovasc Surg. 2015 Dec;150(6):1496-1504, 1505.e1-5; discussion 1504-5. doi: 10.1016/j.jtcvs.2015.08.067. Epub 2015 Aug 28.
The study objective was to study the incidence, predictors, and implications of unanticipated early postoperative readmission after lung resection for non-small cell lung cancer.
Patients undergoing surgery for clinical stage I to III non-small cell lung cancer were abstracted from the National Cancer Database. Regression models were fitted to identify predictors of 30-day readmission and to study the association of unplanned readmission with 30-day and long-term survival.
Between 1998 and 2010, 129,893 patients underwent resection for stage I to III non-small cell lung cancer. Of these, 5624 (4.3%) were unexpectedly readmitted within 30 days. In a multivariate regression model, increasing age, male gender, preoperative radiation, and pneumonectomy (odds ratio, 1.77; 95% confidence interval, 1.56-2.00) were associated with unexpected readmissions. Longer index hospitalization and higher Charlson comorbidity score were also predictive of readmission. The 30-day mortality for readmitted patients was higher (3.9% vs 2.8%), as was the 90-day mortality (7.0% vs 3.3%, both P < .001). In a multivariate Cox proportional hazards model of long-term survival, increasing age, higher Charlson comorbidity score, and higher pathologic stage (hazard ratio, for stage III 1.81; 95% confidence interval, 1.42-2.29) were associated with greater risk of mortality. Unplanned readmission was independently associated with a higher risk of long-term mortality (hazard ratio, 1.40; 95% confidence interval, 1.34-1.47). The median survival for readmitted patients was significantly shorter (38.7 vs 58.5 months, P < .001).
Unplanned readmissions are not rare after resection for non-small cell lung cancer. Such events are associated with a greater risk of short- and long-term mortality. With the renewed national focus on readmissions and potential financial disincentives, greater resource allocation is needed to identify patients at risk and develop measures to avoid the associated adverse outcomes.
本研究旨在探讨非小细胞肺癌肺切除术后意外早期再入院的发生率、预测因素及影响。
从国家癌症数据库中提取临床分期为I至III期非小细胞肺癌手术患者。采用回归模型确定30天再入院的预测因素，并研究计划外再入院与30天及长期生存的关联。
1998年至2010年间，129,893例患者接受了I至III期非小细胞肺癌切除术。其中，5624例（4.3%）在30天内意外再入院。在多变量回归模型中，年龄增加、男性、术前放疗和肺切除术（比值比，1.77；95%置信区间，1.56 - 2.00）与意外再入院相关。较长的首次住院时间和较高的Charlson合并症评分也可预测再入院。再入院患者的30天死亡率较高（3.9%对2.8%），90天死亡率也是如此（7.0%对3.3%，均P <.001）。在长期生存的多变量Cox比例风险模型中，年龄增加、较高的Charlson合并症评分和较高的病理分期（III期的风险比为1.81；95%置信区间，1.42 - 2.29）与更高的死亡风险相关。计划外再入院与更高的长期死亡风险独立相关（风险比，1.40；95%置信区间，1.34 - 1.47）。再入院患者的中位生存期明显较短（38.7对58.5个月，P <.001）。
非小细胞肺癌切除术后计划外再入院并不罕见。此类事件与短期和长期死亡风险增加相关。随着国家重新关注再入院以及潜在的经济处罚措施，需要更多资源分配以识别高危患者并制定措施避免相关不良后果。
