Acher Alexandra W, Squires Malcolm H, Fields Ryan C, Poultsides George A, Schmidt Carl, Votanopoulos Konstantinos I, Pawlik Timothy M, Jin Linda X, Ejaz Aslam, Kooby David A, Bloomston Mark, Worhunsky David, Levine Edward A, Saunders Neil, Winslow Emily, Cho Clifford S, Leverson Glen, Maithel Shishir K, Weber Sharon M
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Emory University, Atlanta, GA, USA.
J Gastrointest Surg. 2016 Jul;20(7):1284-94. doi: 10.1007/s11605-015-3070-2. Epub 2016 Apr 21.
This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival.
Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted.
Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p < 0.0128), American Society of Anesthesiology status ≥3 (p = 0.0045), preexisting cardiac disease (p < 0.0001), hypertension (p = 0.0142), history of smoking (p = 0.0254), increased preoperative blood urea nitrogen (BUN; p = 0.0426), concomitant pancreatectomy (p = 0.0056), increased operation time (p = 0.0384), estimated blood loss (p = 0.0196), 25th percentile length of stay (<7 days, p = 0.0166), 75th percentile length of stay (>12 days, p = 0.0256), postoperative complication (p < 0.0001), and total gastrectomy (p = 0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6-3.3, p < 0.0001), postoperative complication (OR 2.3, 95 % CI 1.6-5.4, p < 0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1-4.1, p = 0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p = 0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p = 0.0002).
Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.
本研究利用多机构数据库评估接受胃癌根治性胃切除术患者再入院的风险因素，旨在描述围手术期风险因素以及再入院与生存的关系。
分析了2000年至2012年期间来自美国胃癌协作组7个学术机构的接受胃癌根治性切除术的患者。排除住院死亡和姑息性手术患者，再入院定义为出院后30天内。采用单因素和多因素逻辑回归分析并进行生存分析。
855例患者中，121例（14.2%）再次入院。单因素分析确定高龄（p<0.0128）、美国麻醉医师协会状态≥3（p=0.0045）、既往有心脏病（p<0.0001）、高血压（p=0.0142）、吸烟史（p=0.0254）、术前血尿素氮（BUN）升高（p=0.0426）、同期胰腺切除术（p=0.0056）、手术时间延长（p=0.0384）、估计失血量（p=0.0196）、第25百分位数住院时间（<7天，p=0.0166）、第75百分位数住院时间（>12天，p=0.0256）、术后并发症（p<0.0001）和全胃切除术（p=0.0167）为再入院的风险因素。多因素分析确定心脏病（比值比（OR）2.4，95%置信区间（CI）为1.6 - 3.3，p<0.0001）、术后并发症（OR 2.3，95%CI为1.6 - 5.4，p<0.0001）和胰腺切除术（OR 2.2，95%CI为1.1 - 4.1，p=0.0202）为再入院的独立风险因素。再入院患者的总体中位生存期降低（再入院患者为39个月，未再入院患者为103个月）。这是由于I期再入院患者生存期降低（p=0.0039），而其他分期患者的生存期无差异。I期再入院患者的心脏病发病率高于I期未再入院患者（分别为58%和！24%，p=0.0002）。
在这项多机构研究中，对接受胃癌根治性切除术患者的再入院情况进行调查，发现心脏病、术后并发症以及同期胰腺切除术是再入院的重要风险因素。再入院与总体中位生存期降低相关，但进一步分析表明，这仅由I期疾病生存期的差异所致。
