Chen Sophia Y, Molena Daniela, Stem Miloslawa, Mungo Benedetto, Lidor Anne O
Sophia Y Chen, Miloslawa Stem, Benedetto Mungo, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
World J Gastroenterol. 2016 Jun 14;22(22):5246-53. doi: 10.3748/wjg.v22.i22.5246.
To identify rates of post-discharge complications (PDC), associated risk factors, and their influence on early hospital outcomes after esophagectomy.
We used the 2005-2013 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients ≥ 18 years of age who underwent an esophagectomy. These procedures were categorized into four operative approaches: transhiatal, Ivor-Lewis, 3-holes, and non-gastric conduit. We selected patient data based on clinical relevance to patients undergoing esophagectomy and compared demographic and clinical characteristics. The primary outcome was PDC, and secondary outcomes were hospital readmission and reoperation. The patients were then divided in 3 groups: no complication (Group 1), only pre-discharge complication (Group 2), and PDC patients (Group 3). A modified Poisson regression analysis was used to identify risk factors associated with developing post-discharge complication, and risk ratios were estimated.
4483 total patients were identified, with 8.9% developing PDC within 30-d after esophagectomy. Patients who experienced complications post-discharge had a median initial hospital length of stay (LOS) of 9 d; however, PDC occurred on average 14 d following surgery. Patients with PDC had greater rates of wound infection (41.0% vs 19.3%, P < 0.001), venous thromboembolism (16.3% vs 8.9%, P < 0.001), and organ space surgical site infection (17.1% vs 11.0%, P = 0.001) than patients with pre-discharge complication. The readmission rate in our entire population was 12.8%. PDC patients were overwhelmingly more likely to have a reoperation (39.5% vs 22.4%, P < 0.001) and readmission (66.9% vs 6.6%, P < 0.001). BMI 25-29.9 and BMI ≥ 30 were associated with increased risk of PDC compared to normal BMI (18.5-25).
PDC after esophagectomy account for significant number of reoperations and readmissions. Efforts should be directed towards optimizing patient's health pre-discharge, with possible prevention programs at discharge.
确定食管癌切除术后出院后并发症（PDC）的发生率、相关危险因素及其对早期住院结局的影响。
我们使用2005 - 2013年美国外科医师学会国家外科质量改进计划（ACS - NSQIP）数据库，识别年龄≥18岁且接受食管癌切除术的患者。这些手术被分为四种手术方式：经裂孔、Ivor - Lewis、三孔法和非胃代食管。我们根据与接受食管癌切除术患者的临床相关性选择患者数据，并比较人口统计学和临床特征。主要结局是PDC，次要结局是再次入院和再次手术。然后将患者分为3组：无并发症（第1组）、仅出院前有并发症（第2组）和PDC患者（第3组）。采用改良泊松回归分析确定与出院后并发症发生相关的危险因素，并估计风险比。
共识别出4483例患者，其中8.9%在食管癌切除术后30天内发生PDC。出院后发生并发症的患者初始住院中位时长（LOS）为9天；然而，PDC平均在术后14天发生。与出院前有并发症的患者相比，PDC患者的伤口感染发生率更高（41.0%对19.3%，P < 0.001）、静脉血栓栓塞发生率更高（16.3%对8.9%，P < 0.001）以及器官腔隙手术部位感染发生率更高（17.1%对11.0%，P = 0.001）。我们总体人群的再入院率为12.8%。PDC患者进行再次手术（39.5%对22.4%，P < 0.001）和再次入院（66.9%对6.6%，P < 0.001）的可能性要大得多。与正常体重指数（18.5 - 25）相比，体重指数25 - 29.9和体重指数≥30与PDC风险增加相关。
食管癌切除术后的PDC导致大量再次手术和再次入院。应致力于优化患者出院前的健康状况，并在出院时开展可能的预防项目。
