上消化道癌手术中强化康复计划的倾向评分分析
Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery.
作者信息
Karran A, Wheat J, Chan D, Blake P, Barlow R, Lewis W G
机构信息
Departments of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
Departments of Dietetics, University Hospital of Wales, Cardiff, CF14 4XW, UK.
出版信息
World J Surg. 2016 Jul;40(7):1645-54. doi: 10.1007/s00268-016-3473-6.
INTRODUCTION
The aim of this study was to examine the influence of an enhanced recovery programme (ERP) on outcomes of upper gastrointestinal (UGI) cancer surgery by means of propensity score-matched analysis.
METHODS
Three hundred consecutive patients diagnosed with UGI cancer were studied prospectively before and after the introduction of an ERP. Multiple regression models, including propensity scores, were developed to assess confounding variables associated with undergoing surgery, and the risk adjusted association between treatment and length of hospital stay (LOHS).
RESULTS
After regression for confounding factors, a cohort of 252 patients was available of whom 160 received ERP [median age 66 years (IQR 58-73), 119 male, 81 oesophageal, 79 gastric cancer] and 92 control [66 years (IQR 58-74), 74 male, 58 oesophageal, 34 gastric cancer]. ERP operative morbidity (Clavien-Dindo ≥3) and mortality were 13.8 and 3.1 % compared with 17.4 (p = 0.449) and 2.2 % (p = 0.658) in controls. Median ERP critical care and total LOS were 1 (IQR 0-1) and 13 (IQR 10-17) days, compared with 1 (IQR 1-2, p = 0.009) and 16 (IQR 13-26, p < 0.001) days. Multivariable analysis revealed ERP (HR 1.477, 95 % CI 1.084-2.013, p = 0.013), tumour location (HR 2.420, 95 % CI 1.624-3.606, p < 0.001), operative procedure (HR 1.143, 95 % CI 1.032-1.265, p = 0.010), and operative morbidity (HR 0.277, 95 % CI 0.179-0.429, p < 0.001) to be associated with LOHS.
CONCLUSION
An ERP in UGI cancer surgery was feasible, safe, and effective.
引言
本研究旨在通过倾向得分匹配分析，探讨强化康复计划（ERP）对上消化道（UGI）癌手术结局的影响。
方法
对连续300例诊断为UGI癌的患者在引入ERP前后进行前瞻性研究。建立包括倾向得分在内的多元回归模型，以评估与接受手术相关的混杂变量，以及治疗与住院时间（LOHS）之间的风险调整关联。
结果
在对混杂因素进行回归分析后，得到一组252例患者，其中160例接受ERP治疗[中位年龄66岁（四分位间距58 - 73），男性119例，食管癌81例，胃癌79例]，92例为对照组[66岁（四分位间距58 - 74），男性74例，食管癌58例，胃癌34例]。ERP组的手术并发症（Clavien-Dindo≥3级）和死亡率分别为13.8%和3.1%，而对照组分别为17.4%（p = 0.449）和2.2%（p = 0.658）。ERP组的中位重症监护时间和总住院时间分别为1天（四分位间距0 - 1）和13天（四分位间距10 - 17），而对照组分别为1天（四分位间距1 - 2，p = 0.009）和16天（四分位间距13 - 26，p < 0.001）。多变量分析显示，ERP（风险比1.477，95%置信区间1.084 - 2.013，p = 0.013）、肿瘤位置（风险比2.420，95%置信区间1.624 - 3.606，p < 0.001）、手术操作（风险比1.143，95%置信区间1.032 - 1.265，p = 0.010）和手术并发症（风险比0.277，95%置信区间0.
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