Department of Surgery, George Washington University, 2150 Pennsylvania Ave. NW, Suite 6B, Washington, DC 20037, United States.
Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States.
Am J Surg. 2018 Apr;215(4):636-642. doi: 10.1016/j.amjsurg.2017.06.040. Epub 2017 Sep 18.
Complex surgeries such as a pancreatoduodenectomy (PD) traditionally have long hospital stays (LOS).
Patients who underwent elective PD at our institution from 8/2011-6/2015 were retrospectively examined. Interquartile ranges were calculated from LOS. Patient were compared between the highest quartile and the remainder of the cohort.
492 patients had a median LOS of 9 days, with 106 (22%) admitted for >14 days. Characteristics associated with prolong hospitalization include age (p = 0.004) and preoperative albumin <3.5 (p = 0.007). Significant intra-operative measures associated with prolonged LOS were blood loss (EBL, p = 0.004) and increased operative time (p = 0.008). Any complication extended hospitalizations (p < 0.001). Patients in the top quartile were less likely to be discharged home (p < 0.0001) and more likely to be readmitted (p < 0.0001).
Older patients with hypoalbuminemia are at higher risk of prolonged LOS following PD as well as high EBL, operative time, and surgical complications. Focused efforts to counsel and optimize patients pre-operatively and minimize intra-operative complications may shorten hospital stays.
复杂的手术，如胰十二指肠切除术（PD），传统上需要较长的住院时间（LOS）。
回顾性检查了我院 2011 年 8 月至 2015 年 6 月期间择期行 PD 的患者。 LOS 计算了四分位数范围。将最高四分位数组与队列其余部分的患者进行了比较。
492 例患者的中位 LOS 为 9 天，106 例（22%）住院时间>14 天。与延长住院时间相关的特征包括年龄（p=0.004）和术前白蛋白<3.5（p=0.007）。与 LOS 延长显著相关的术中措施包括出血量（EBL，p=0.004）和手术时间延长（p=0.008）。任何并发症都延长了住院时间（p<0.001）。处于最高四分位数的患者出院回家的可能性较小（p<0.0001），再次入院的可能性较大（p<0.0001）。
PD 后白蛋白水平低、EBL 高、手术时间长和手术并发症的老年患者 LOS 延长的风险更高。术前有针对性地对患者进行咨询和优化，并尽量减少术中并发症，可能会缩短住院时间。
