Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA.
Moores Cancer Center, UCSD, San Diego, CA, USA.
Ann Surg Oncol. 2018 Jan;25(1):91-97. doi: 10.1245/s10434-017-6108-8. Epub 2017 Oct 31.
Readmission rates following surgery are subject to scrutiny in efforts to control health care costs. This study was designed to define the 60-day readmission rate following cytoreduction and HIPEC at a high-volume center and to identify factors associated with readmission.
Patients who underwent complete cytoreduction and HIPEC at a single institution from August 2007 through June 2014 were identified from a prospectively maintained database. Multiple preoperative and operative factors were analyzed for their ability to predict 60-day readmission following surgery.
A total of 250 patients were identified. Forty patients (17%) experienced readmission within 60 days of surgery. The most common reasons for readmission were ileus/dehydration (12, 31%), deep space infection (8, 21%), and DVT/PE (6, 15%). Initial postoperative length of stay was longer for patients readmitted within 60 days (median 12 vs. 9 days, p = 0.013). Of categorical variables analyzed, including gender, histology, HIPEC agent, intraoperative transfusion, and individual procedures performed during cytoreduction, adjuvant systemic therapy, and postoperative morbidity, only Charlson comorbidity index CCI (odds ratio (OR) = 3.80 [1.68-8.60]) and stoma creation (OR = 6.04 [1.56-12.14]) were associated with 60-day readmission.
Few measurable variables are associated with readmission following cytoreduction and HIPEC. Patients with high CCI and those with stomas created at the time of CRS/HIPEC may be at increased risk of readmission within 60 days. Earlier or more frequent follow-up for high-risk patients should be considered as a strategy to reduce readmissions.
在控制医疗成本的努力中，手术后的再入院率受到严格审查。本研究旨在定义在高容量中心进行细胞减灭术和 HIPEC 后 60 天的再入院率，并确定与再入院相关的因素。
从 2007 年 8 月至 2014 年 6 月，从一家单机构的前瞻性维护数据库中确定了接受完全细胞减灭术和 HIPEC 的患者。分析了多种术前和手术因素，以预测手术后 60 天的再入院率。
共确定了 250 例患者。40 例（17%）在手术后 60 天内再次入院。再入院的最常见原因是肠梗阻/脱水（12 例，31%）、深部空间感染（8 例，21%）和 DVT/PE（6 例，15%）。60 天内再次入院的患者术后首次住院时间较长（中位数 12 天 vs. 9 天，p=0.013）。在分析的分类变量中，包括性别、组织学、HIPEC 药物、术中输血以及细胞减灭术中进行的单个手术、辅助全身治疗和术后发病率，只有 Charlson 合并症指数 CCI（比值比（OR）=3.80[1.68-8.60]）和造口术（OR=6.04[1.56-12.14]）与 60 天再入院相关。
少数可衡量的变量与细胞减灭术和 HIPEC 后再入院相关。CCI 较高的患者和在 CRS/HIPEC 时造口的患者在 60 天内再入院的风险可能增加。应考虑为高危患者提供更早或更频繁的随访，以降低再入院率。
