Cholankeril G, Hu M, Tanner E, Cholankeril R, Reha J, Somasundar P
Department of Internal Medicine, 825 Chalkstone Avenue, Roger Williams Medical Center, Providence, RI, 02908, United States; Department of Medicine, 72 East Concord Street, Boston University School of Medicine, Boston, MA, 02118, United States.
Department of Biostatistics, 121 South Main Street, Brown University School of Public Health, Providence, RI, 02903, United States.
Eur J Surg Oncol. 2016 Nov;42(11):1660-1666. doi: 10.1016/j.ejso.2016.06.005. Epub 2016 Jun 17.
The current study sought to determine predictive risk factors and inpatient resource utilization associated with discharge to skilled nursing facility (SNF) in hospitalized elderly patients with colon cancer.
Inpatient data from U.S. community hospital discharges from 2003 to 2011 was analyzed in a retrospective cohort study using the Healthcare Cost and Utilization Project, National Inpatient Sample (HCUP-NIS). Subjects included hospitalized postoperative colon cancer patients over age of 65 (N = 98,797).
The proportion of elderly colon cancer patients discharged to a SNF increased by 16.67% from 2003 to 2011 (18-21%). Elderly patients discharged to a SNF had increased hospitalization costs (+$10,293.70, p < 0.01) compared to elderly colon cancer patients discharged home. Hospitalization predictive risk factors associated with SNF placement include age above 75 (OR, 4.07; 95% CI, 3.90, 4.25; p < 0.01), paralysis (OR, 3.60; 95% CI, 3.06-4.23; p < 0.01), length of stay (LOS) 10 days or more (OR, 3.00; 95% CI, 2.88-3.13; p < 0.01), psychoses (OR, 2.91; 95% CI, 2.56-3.32; p < 0.01), and neurological disorders (OR, 2.34; 95% CI, 2.17-2.52; p < 0.01).
Despite increased costs and worse clinical outcomes associated with SNF placement, over 40% increase of hospital discharge to SNF should be anticipated from this population over the next 20 years. Neurologic and psychiatric comorbidities have significantly negative clinical impacts and increase the likelihood of colon cancer patients' discharge to a SNF.
本研究旨在确定老年结肠癌住院患者出院至专业护理机构（SNF）的预测风险因素及住院资源利用情况。
在一项回顾性队列研究中，使用医疗成本与利用项目国家住院样本（HCUP-NIS）分析了2003年至2011年美国社区医院出院的住院患者数据。研究对象包括65岁以上的住院结肠癌术后患者（N = 98,797）。
2003年至2011年，出院至SNF的老年结肠癌患者比例增加了16.67%（从18%增至21%）。与出院回家的老年结肠癌患者相比，出院至SNF的老年患者住院费用增加（增加10,293.70美元，p < 0.01）。与入住SNF相关的住院预测风险因素包括75岁以上（OR，4.07；95% CI，3.90，4.25；p < 0.01）、瘫痪（OR，3.60；95% CI，3.06 - 4.23；p < 0.01）、住院时间（LOS）10天或更长（OR，3.00；95% CI，2.88 - 3.13；p < 0.01）、精神病（OR，2.91；95% CI，2.56 - 3.32；p < 0.01）和神经疾病（OR，2.34；95% CI，2.17 - 2.52；p < 0.01）。
尽管入住SNF会增加成本且临床结局更差，但预计未来20年该人群出院至SNF的比例将增加40%以上。神经和精神合并症具有显著的负面临床影响，并增加了结肠癌患者出院至SNF的可能性。
