Curtis N J, Noble E, Salib E, Hipkiss R, Meachim E, Dalton R, Allison A, Ockrim J, Francis N K
Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK.
Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
Colorectal Dis. 2017 Aug;19(8):723-730. doi: 10.1111/codi.13603.
Hospital readmission is undesirable for patients and care providers as this can affect short-term recovery and carries financial consequences. It is unknown if readmission has long-term implications. We aimed to investigate the impact of 30-day readmission on long-term overall survival (OS) following colorectal cancer resection within enhanced recovery after surgery (ERAS) care and explore the reasons for and the severity and details of readmission episodes.
A dedicated, prospectively populated database was reviewed. All patients were managed within an established ERAS programme. Five-year OS was calculated using the Kaplan-Meier method. The number, reason for and severity of 30-day readmissions were classified according to the Clavien-Dindo (CD) system, along with total (initial and readmission) length of stay (LoS). Multivariate analysis was used to identify factors predicting readmission.
A total of 1023 consecutive patients underwent colorectal cancer resection between 2002 and 2015. Of these, 166 (16%) were readmitted. Readmission alone did not have a significant impact on 5-year OS (59% vs 70%, P = 0.092), but OS was worse in patients with longer total LoS (20 vs 14 days, P = 0.04). Of the readmissions, 121 (73%) were minor (CD I-II) and 27 (16%) required an intervention of which 16 (10%) were returned to theatre. Gut dysfunction 32 (19%) and wound complications 23 (14%) were the most frequent reasons for readmission. Prolonged initial LoS, rectal cancer and younger age predicted for hospital readmission.
Readmission does not have a significant impact on 5-year OS. A broad range of conditions led to readmission, with the majority representing minor complications.
医院再入院对患者和医护人员来说都不理想，因为这会影响短期康复并带来经济后果。目前尚不清楚再入院是否具有长期影响。我们旨在研究结直肠癌切除术后30天再入院对手术加速康复（ERAS）护理下长期总生存期（OS）的影响，并探讨再入院事件的原因、严重程度及细节。
回顾了一个专门的前瞻性数据库。所有患者均在既定的ERAS计划下接受治疗。采用Kaplan-Meier法计算5年总生存期。根据Clavien-Dindo（CD）系统对30天再入院的次数、原因和严重程度进行分类，同时计算总（初次和再入院）住院时间（LoS）。采用多变量分析来确定预测再入院的因素。
2002年至2015年期间，共有1023例连续患者接受了结直肠癌切除术。其中，166例（16%）再次入院。单纯再入院对5年总生存期没有显著影响（59%对70%，P = 0.092），但总住院时间较长的患者总生存期较差（20天对14天，P = 0.04）。在再入院患者中，121例（73%）为轻度（CD I-II级），27例（16%）需要干预，其中16例（10%）返回手术室。肠道功能障碍32例（19%）和伤口并发症23例（14%）是再入院最常见的原因。初次住院时间延长、直肠癌和年轻是医院再入院的预测因素。
再入院对5年总生存期没有显著影响。多种情况导致了再入院，大多数为轻度并发症。
