Honda Michitaka, Hiki Naoki, Nunobe Souya, Ohashi Manabu, Mine Shinji, Watanabe Masayuki, Kamiya Satoshi, Irino Tomoyuki, Sano Takeshi, Yamaguchi Toshiharu
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2016 Jul;19(3):1002-7. doi: 10.1007/s10120-015-0553-5. Epub 2015 Oct 7.
The objectives of this study were to evaluate the incidence of and the risk factors for readmission after gastrectomy. Our hypothesis was that early discharge may be related to an increase in the incidence of readmission.
This was a retrospective, single-center, observational study of 1442 patients who underwent gastrectomy for stage I gastric cancer. The main outcome was the incidence of early readmission after gastrectomy, which was defined as an admission within 6 months after the first discharge day. A stepwise logistic regression analysis was conducted to identify the risk factors for readmission after gastrectomy.
The surgical procedures performed were total gastrectomy in 217 patients (15.0 %), distal gastrectomy in 845 patients (58.6 %), pylorus-preserving gastrectomy in 342 patients (23.7 %), and proximal gastrectomy in 37 patients (2.6 %). The median hospital stay was 11 days, and there were 63 readmissions for a total of 56 patients (3.8 %). The main reasons for readmission were poor food intake in 14 patients (22.2 %), anastomotic stricture in nine patients (14.3 %), small bowel obstruction in eight patients (12.7 %), and an abdominal distension in seven patients (11.1 %). Endoscopic balloon dilation was performed for the nine patients with anastomotic stricture, drainage was needed for the four patients with an intra-abdominal abscess, and laparotomy was performed for one patient with adhesion-associated bowel obstruction. The long hospitalization during the primary admission and patients who underwent total gastrectomy were risk factors for readmission.
Patients with a long hospital stay after gastrectomy are at an increased risk of early readmission, which was likely related to the incidence of severe sequelae specific to gastrectomy.
本研究的目的是评估胃癌切除术后再入院的发生率及危险因素。我们的假设是早期出院可能与再入院发生率增加有关。
这是一项对1442例行I期胃癌胃切除术患者的回顾性、单中心观察性研究。主要结局是胃切除术后早期再入院的发生率，定义为首次出院日起6个月内再次入院。进行逐步逻辑回归分析以确定胃切除术后再入院的危险因素。
所施行的手术方式为：全胃切除术217例（15.0%），远端胃切除术845例（58.6%），保留幽门胃切除术342例（23.7%），近端胃切除术37例（2.6%）。中位住院时间为11天，共有56例患者63次再入院（3.8%）。再入院的主要原因是：14例患者（22.2%）进食差，9例患者（14.3%）吻合口狭窄，8例患者（12.7%）小肠梗阻，7例患者（11.1%）腹胀。对9例吻合口狭窄患者进行了内镜球囊扩张，4例腹腔内脓肿患者需要引流，1例粘连性肠梗阻患者进行了剖腹手术。初次住院时间长及行全胃切除术的患者是再入院的危险因素。
胃切除术后住院时间长的患者早期再入院风险增加，这可能与胃切除术特有的严重后遗症发生率有关。
