Xia Leilei, Taylor Benjamin L, Pulido Jose E, Mucksavage Phillip, Lee David I, Guzzo Thomas J
Division of Urology, Department of Surgery, Perelman School of Medicine University of Pennsylvania , Philadelphia, Pennsylvania.
J Endourol. 2017 Sep;31(9):864-871. doi: 10.1089/end.2017.0293. Epub 2017 Aug 30.
Robot-assisted radical prostatectomy (RARP) has become the preferred surgical treatment for localized prostate cancer in the United States. Little is reported about the association between predischarge outcomes and postdischarge outcomes following RARP. The objective of this study was to explore the predischarge predictors of readmissions and postdischarge complications in RARP.
The National Surgery Quality Improvement Program (NSQIP) database was used to identify prostate cancer patients who underwent elective RARP from 2012 to 2014. Multivariable logistic regression was performed to assess potential predischarge predictors of readmissions and NSQIP-defined postdischarge complications within 30 days of RARP. To test the robustness of primary analysis, a secondary multivariable logistic regression was performed in the cohort of patients without any NSQIP-defined predischarge complications.
A total of 9975 patients were included. The readmission rate in the cohort was 3.3% (n = 332), and 4.4% (n = 441) had at least one complication. Multivariable logistic regression showed that American Society of Anesthesiologists (ASA) score of 3-4 (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.00-1.62, p = 0.050), increasing operative time (OT, per minute) (OR = 1.002, 95% CI = 1.000-1.003, p = 0.012), increasing length of hospital stay (LOS, per day) (OR = 1.36, 95% CI = 1.23-1.49, p < 0.001), and predischarge complication (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) were associated with readmission. Increasing OT (OR = 1.002, 95% CI = 1.001-1.004, p = 0.002) and increasing LOS (OR = 1.16, 95% CI = 1.02-1.30, p = 0.020) were associated with postdischarge complications. Logistic regression in patients without predischarge complications (n = 9804) confirmed that ASA score of 3-4 (OR = 1.37, 95% CI = 1.07-1.75, p = 0.013), increasing OT (OR = 1.002, 95% CI = 1.000-1.003, p = 0.022), and increasing LOS (OR = 1.34, 95% CI = 1.21-1.49, p < 0.001) were associated with readmissions. Secondary analyses also confirmed that increasing OT (OR = 1.002, 95% CI = 1.001-1.004, p = 0.002) and increasing LOS (OR = 1.18, 95% CI = 1.04-1.34, p = 0.011) were associated with postdischarge complications.
Predischarge complications, OT, and LOS are associated with readmissions and postdischarge complications after RARP. It may be possible to identify patients at a higher risk of postdischarge adverse events to direct prevention interventions. Further prospective studies are needed to validate our findings.
机器人辅助根治性前列腺切除术（RARP）已成为美国局限性前列腺癌的首选手术治疗方式。关于RARP术后出院前结局与出院后结局之间的关联，报道较少。本研究的目的是探讨RARP术后再入院和出院后并发症的出院前预测因素。
利用国家外科质量改进计划（NSQIP）数据库，识别2012年至2014年接受择期RARP的前列腺癌患者。进行多变量逻辑回归分析，以评估RARP术后30天内再入院和NSQIP定义的出院后并发症的潜在出院前预测因素。为检验主要分析的稳健性，在无任何NSQIP定义的出院前并发症的患者队列中进行了二次多变量逻辑回归分析。
共纳入9975例患者。该队列中的再入院率为3.3%（n = 332），4.4%（n = 441）有至少一种并发症。多变量逻辑回归分析显示，美国麻醉医师协会（ASA）评分为3 - 4分（比值比[OR] = 1.27，95%置信区间[CI] = 1.00 - 1.62，p = 0.050）、手术时间（OT，每分钟）增加（OR = 1.002，95% CI = 1.000 - 1.003，p = 0.012）、住院时间（LOS，每天）增加（OR = 1.36，95% CI = 1.23 - 1.49，p < 0.001）以及出院前并发症（OR = 2.15，95% CI = 1.27 - 3.65，p = 0.004）与再入院相关。OT增加（OR = 1.002，95% CI = 1.001 - 1.004，p = 0.002）和LOS增加（OR = 1.16，95% CI = 1.02 - 1.30，p = 0.020）与出院后并发症相关。无出院前并发症患者（n = 9804）的逻辑回归分析证实，ASA评分为3 - 4分（OR = 1.37，95% CI = 1.07 - 1.75，p = 0.013）、OT增加（OR = 1.002，95% CI = 1.000 - 1.003，p = 0.022）和LOS增加（OR = 1.34，95% CI = 1.21 - 1.49，p < 0.001）与再入院相关。二次分析也证实，OT增加（OR = 1.002，95% CI = 1.001 - 1.004，p = 0.002）和LOS增加（OR = 1.18，95% CI = 1.04 - 1.34，p = 0.011）与出院后并发症相关。
出院前并发症、OT和LOS与RARP术后再入院和出院后并发症相关。有可能识别出出院后发生不良事件风险较高的患者，以便进行直接的预防干预。需要进一步的前瞻性研究来验证我们的发现。
