Helman Samuel N, Brant Jason A, Moubayed Sami P, Newman Jason G, Cannady Steven B, Chai Raymond L
Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Laryngoscope. 2017 Jun;127(6):1339-1344. doi: 10.1002/lary.26454. Epub 2016 Dec 21.
OBJECTIVES/HYPOTHESIS: To identify relevant patient and surgical risk factors associated with prolonged length of stay, return to the operating room, and readmission within 30 days following total laryngectomy using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) STUDY DESIGN: Retrospective database study. Patients undergoing total laryngectomy alone for laryngeal cancer were identified from the ACS-NSQIP database from 2005 to 2014.
Multivariate logistic regression was used to identify independent predictors for prolonged length of stay, readmissions, and unplanned reoperations within 30 days.
Among 871 patients meeting inclusion and exclusion criteria, the median length of stay was 8.0 days (range, 0-130 days). Totally dependent functional status (P < .01; odds ratio [OR]: 32.62), Black or African American race (P = .029; OR: 1.75), and operative time (P < .0001; OR: 1.15) were associated with prolonged length of stay. The overall rate of return to the operating room within 30 days was 12.4%. Contaminated wound status (P = .025; OR: 3.53), operative time (P = .015; OR: 1.10), steroid use (P < .01; OR: 2.92), and smoking (P = .05; OR: 1.60) were significantly associated with return to the operating room. Unplanned readmission rate was 11.9%, and 47.37% of readmissions were due to wound infection/pharyngocutaneous fistula. Dirty/contaminated wound classification (P = .05; OR: 22.5) was associated with readmission on multivariate analysis.
This is the first population-level analysis to be performed on length of stay, readmission, and reoperation for total laryngectomy. Assessing and identifying modifiable risk factors on quality metrics may reduce overall cost and the burden on limited hospital resources.
目的/假设：利用美国外科医师学会国家质量改进计划（ACS-NSQIP）确定全喉切除术后住院时间延长、返回手术室以及30天内再入院的相关患者和手术风险因素。研究设计：回顾性数据库研究。从2005年至2014年的ACS-NSQIP数据库中识别仅因喉癌接受全喉切除术的患者。
采用多因素逻辑回归确定住院时间延长、再入院以及30天内非计划再次手术的独立预测因素。
在871例符合纳入和排除标准的患者中，中位住院时间为8.0天（范围0 - 130天）。完全依赖功能状态（P < 0.01；比值比[OR]：32.62）、黑人或非裔美国人种族（P = 0.029；OR：1.75）以及手术时间（P < 0.0001；OR：1.15）与住院时间延长相关。30天内返回手术室的总体发生率为12.4%。伤口污染状态（P = 0.025；OR：3.53）、手术时间（P = 0.015；OR：1.10）、使用类固醇（P < 0.01；OR：2.92）以及吸烟（P = 0.05；OR：1.60）与返回手术室显著相关。非计划再入院率为11.9%，47.37%的再入院是由于伤口感染/咽皮肤瘘。在多因素分析中，脏污/污染伤口分类（P = 0.05；OR：22.5）与再入院相关。
这是首次对全喉切除术的住院时间、再入院和再次手术进行的人群水平分析。评估和识别质量指标上的可改变风险因素可能会降低总体成本以及减轻有限医院资源的负担。
4。《喉镜》，127:1339 - 1344，2017年。
