McIntosh Andrew G, Li Tianyu, Ito Timothy, Mannion Jason, Dziemianowicz Mark, Waingankar Nikhil, Haseebuddin Mohammed, Chen David Y T, Greenberg Richard E, Viterbo Rosalia, Kutikov Alexander, Uzzo Robert G, Smaldone Marc C, Abbosh Philip H
Temple University Health System, Philadelphia, PA, USA.
Fox Chase Cancer Center, Philadelphia, PA, USA.
Bladder Cancer. 2017 Apr 27;3(2):95-103. doi: 10.3233/BLC-160088.
Radical cystectomy is associated with perioperative complication rates exceeding 50% in some series. Readmission rates are increasingly used as a surgical quality metric. White blood cell count is a crude surrogate for physiologic processes which may reflect postoperative complications leading to readmission. We assessed the association between final white blood cell count at discharge and risk of readmission following radical cystectomy. Records on 477 patients undergoing radical cystectomy from 2006-2013 were reviewed. Final white blood cell count was defined as the last documented value during index admission. Univariate analysis was performed using Fisher's exact, Wilcoxon rank sum test, and Spearman's coefficient tests where appropriate. Multivariable logistic regression models were used to test the associations between final white blood cell count and readmission. 34% of patients were readmitted within 90 days of surgery. Amongst this cohort, a cutoff final white blood cell count of 9000/mm was identified, with a significantly higher proportion of patients with values >9000/mm experiencing readmission than those with values≤9000/mm (42% vs 28%, = 0.004). Other perioperative variables associated with an increased readmission rate included initial hospital length of stay≤10 days, and receipt of a continent diversion. Following adjustment, final white blood cell count >9000/mm was associated with increased risk of readmission (OR 2.09, 95% CI 1.23-3.53, = 0.006). Final white blood cell count is associated with hospital readmission following radical cystectomy. This metric may provide important guidance in discharge algorithms.
在某些系列研究中，根治性膀胱切除术的围手术期并发症发生率超过50%。再入院率越来越多地被用作手术质量指标。白细胞计数是生理过程的一个粗略替代指标，可能反映导致再入院的术后并发症。我们评估了根治性膀胱切除术后出院时的最终白细胞计数与再入院风险之间的关联。回顾了2006年至2013年期间477例行根治性膀胱切除术患者的记录。最终白细胞计数定义为首次入院期间记录的最后值。在适当情况下，使用Fisher精确检验、Wilcoxon秩和检验和Spearman系数检验进行单变量分析。多变量逻辑回归模型用于检验最终白细胞计数与再入院之间的关联。34%的患者在术后90天内再次入院。在该队列中，确定最终白细胞计数的临界值为9000/mm³，白细胞计数>9000/mm³的患者再入院的比例显著高于白细胞计数≤9000/mm³的患者（42%对28%，P = 0.004）。与再入院率增加相关的其他围手术期变量包括初始住院时间≤10天以及接受可控性尿流改道术。调整后，最终白细胞计数>9000/mm³与再入院风险增加相关（比值比2.09，95%置信区间1.23 - 3.53，P = 0.006）。根治性膀胱切除术后最终白细胞计数与医院再入院相关。该指标可能为出院算法提供重要指导。
