Balentine Courtney J, Richardson Peter A, Mason Meredith C, Naik Aanand D, Berger David H, Anaya Daniel A
*Department of Surgery, University of Wisconsin, Madison, WI†Houston Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX‡Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX§Alkek Department of Medicine, Baylor College of Medicine, Houston, TX¶Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
Ann Surg. 2017 May;265(5):993-999. doi: 10.1097/SLA.0000000000001758.
To determine whether postacute care (PAC) facilities can compensate for increased mortality stemming from a complicated postoperative recovery (complications or deconditioning).
An increasing number of patients having cancer surgery rely on PAC facilities including skilled nursing and rehabilitation centers to help them recover from postoperative complications and the physical demands of surgery. It is currently unclear whether PAC can successfully compensate for the adverse consequences of a complicated postoperative recovery.
We combined data from the Veterans Affairs Cancer Registry with the Surgical Quality Improvement Program to identify veterans having surgery for stage I-III colorectal cancer from 1999 to 2010. We used propensity matching to control for comorbidity, functional status, postoperative complications, and stage.
We evaluated 10,583 veterans having colorectal cancer surgery, and 765 veterans (7%) were discharged to PAC facilities whereas 9818 veterans (93%) were discharged home. Five-year overall survival after discharge to PAC facilities was 36% compared with 51% after discharge home. Stage I patients discharged to PAC facilities had similar survival (45%) as stage III patients who were discharged home (44%). Patients discharged to PAC facilities had worse survival in the first year after surgery (hazard ratio 2.0, 95% confidence interval 1.7-2.4) and after the first year (hazard ratio 1.4, 95% confidence interval 1.2-1.5).
Discharge to PAC facilities after cancer surgery is not sufficient to overcome the adverse survival effects of a complicated postoperative recovery. Improvement of perioperative care outside the acute hospital setting and development of better postoperative recovery programs for cancer patients are needed to enhance survival after surgery.
确定急性后期护理（PAC）机构能否弥补因术后恢复复杂（并发症或身体机能减退）而导致的死亡率上升。
越来越多接受癌症手术的患者依赖PAC机构，包括专业护理和康复中心，以帮助他们从术后并发症和手术对身体的要求中恢复过来。目前尚不清楚PAC能否成功弥补术后恢复复杂带来的不良后果。
我们将退伍军人事务部癌症登记处的数据与手术质量改进计划相结合，以识别1999年至2010年接受I - III期结直肠癌手术的退伍军人。我们使用倾向匹配法来控制合并症、功能状态、术后并发症和分期。
我们评估了10583名接受结直肠癌手术的退伍军人，其中765名退伍军人（7%）出院后前往PAC机构，而9818名退伍军人（93%）出院回家。出院后前往PAC机构的患者五年总生存率为36%，而出院回家的患者为51%。出院前往PAC机构的I期患者生存率（45%）与出院回家的III期患者（44%）相似。出院前往PAC机构的患者在术后第一年（风险比2.0，95%置信区间1.7 - 2.4）和第一年之后（风险比1.4，置信区间1.2 - 1.5）生存率较差。
癌症手术后出院前往PAC机构不足以克服术后恢复复杂对生存的不利影响。需要改善急性医院环境之外的围手术期护理，并为癌症患者制定更好的术后恢复计划，以提高术后生存率。
