Slankamenac Ksenija, Slankamenac Maja, Schlegel Andrea, Nocito Antonio, Rickenbacher Andreas, Clavien Pierre-Alain, Turina Matthias
Department of Surgery, University Hospital Zurich, Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Institute of Emergency Medicine, University Hospital of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Int J Colorectal Dis. 2017 Jun;32(6):805-811. doi: 10.1007/s00384-017-2811-y. Epub 2017 Apr 14.
It is well known that specific postoperative complications such as stroke influence readmissions and overall survival (OS) after surgery for colorectal cancer (CRC). Whether overall hospital morbidity is associated with increased risk of readmission and poorer long-term survival is unknown. New tools are available to accurately quantify overall morbidity, such as the comprehensive complication index (CCI). The aim is to evaluate the impact of complications on readmission and overall survival (OS) in patients operated for colorectal cancer.
Postoperative complications of patients undergoing surgery for CRC were assessed over a 5-year period using the Clavien-Dindo classification, and overall morbidity was assessed by using the CCI. Individual scores were analyzed regarding their association with readmission and OS by using the multivariate logistic and Cox proportional-hazards regression analysis, respectively.
Two hundred eighty-four patients were operated for CRC, of which 22 (8%) were readmitted. One hundred five patients (37%) developed at least one postoperative complication during the hospital stay. While single complications or the use of severe complication only (grade ≥IIIb) was not associated with readmission, overall morbidity (CCI) predicted readmission (OR 1.02 (95% CI 1.0-1.04), p = 0.044). Similarly, morbidity assessed by the CCI had a significant negative predictive value on OS, e.g., patients with a CCI of 20 were 22% more likely to die within a 5-year follow-up, when compared to patients with a CCI of 10 (p = 0.022).
Overall combined morbidity as assessed by the CCI leads to more frequent readmission, and is associated with poorer long-term survival after surgery for CRC.
众所周知，特定的术后并发症如中风会影响结直肠癌（CRC）手术后的再入院率和总生存期（OS）。目前尚不清楚总体医院发病率是否与再入院风险增加和长期生存率降低相关。现在有一些新工具可用于准确量化总体发病率，如综合并发症指数（CCI）。本研究旨在评估并发症对接受结直肠癌手术患者再入院率和总生存期（OS）的影响。
采用Clavien-Dindo分类法对接受CRC手术患者的术后并发症进行了为期5年的评估，并使用CCI评估总体发病率。分别采用多因素logistic回归分析和Cox比例风险回归分析，分析个体评分与再入院率和OS的相关性。
284例患者接受了CRC手术，其中22例（8%）再次入院。105例患者（37%）在住院期间至少发生了一种术后并发症。虽然单一并发症或仅使用严重并发症（≥IIIb级）与再入院无关，但总体发病率（CCI）可预测再入院率（OR 1.02（95%CI 1.0-1.04），p = 0.044）。同样，CCI评估的发病率对OS具有显著的负预测价值，例如，CCI为20的患者在5年随访内死亡的可能性比CCI为10的患者高22%（p = 0.022）。
CCI评估的总体合并发病率导致更频繁的再入院，并与CRC手术后较差的长期生存率相关。
