胸腔镜与开放性肺癌切除术后非计划再入院的全国性分析。
National Analysis of Unplanned Readmissions After Thoracoscopic Versus Open Lung Cancer Resection.
作者信息
Bhagat Rohun, Bronsert Michael R, Ward Austin N, Martin Jeremiah, Juarez-Colunga Elizabeth, Glebova Natalia O, Henderson William G, Fullerton David, Weyant Michael J, Mitchell John D, Meguid Robert A
机构信息
Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Surgical Outcomes and Applied Research Program (SOAR), University of Colorado School of Medicine, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado.
出版信息
Ann Thorac Surg. 2017 Dec;104(6):1782-1790. doi: 10.1016/j.athoracsur.2017.08.047. Epub 2017 Nov 1.
BACKGROUND
Hospital readmissions are viewed as a mark of inferior health care quality and are penalized. Unplanned postoperative readmission reason and timing after lung resection are not well understood. We examine related, unplanned readmissions after thoracoscopic versus open anatomic lung resections to identify opportunities to improve patient care.
METHODS
We analyzed the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data set, 2012 to 2015, characterizing 30-day related, unplanned postoperative readmissions after anatomic lung resections for primary lung cancer. Risk-adjusted comparison of readmission after thoracoscopic and open resection was performed using propensity matching.
RESULTS
Patients (n = 9,510) underwent anatomic lung resections; 4,935 (51.9%) were thoracoscopic resections and 4,575 (48.1%) were open resections. Of the thoracoscopic patients, 10.9% experienced one or more complications, versus 19.4% of patients with open resection (p < 0.0001). Of the thoracoscopic patients 5.5% experienced related, unplanned readmissions versus 7.2% of the patients with open resection (p < 0.001). 24.8% of complications after thoracoscopic approach occurred after discharge, versus 15.5% after open approach (p < 0.0001). Timing of unplanned readmission was similar for both groups. The propensity-matched odds ratio of risk of readmission after thoracoscopic versus open resection was 1.16 (95% confidence interval, 0.949 to 1.411, p = 0.15).
CONCLUSIONS
Open anatomic lung resections for primary lung cancer had nearly twice the complication rate but only a slightly higher readmission rate than thoracoscopic resection. More complications occurred after discharge after thoracoscopic than open resections. Most readmissions occurred within 2 weeks after both thoracoscopic and open resections. Risk-adjusted comparison identified no statistically significant difference in risk of related, unplanned readmission after thoracoscopic versus open resections. Future studies should focus on identification of processes of care to decrease complications and unplanned readmissions after lung cancer resection.
背景
医院再入院被视为医疗质量低下的标志并会受到处罚。肺切除术后计划外再入院的原因和时间尚不清楚。我们研究胸腔镜与开放性解剖性肺切除术后相关的计划外再入院情况，以确定改善患者护理的机会。
方法
我们分析了美国外科医师学会国家外科质量改进计划（ACS NSQIP）2012年至2015年的数据集，对原发性肺癌解剖性肺切除术后30天相关的计划外术后再入院情况进行了特征分析。使用倾向匹配法对胸腔镜和开放性切除术后再入院情况进行风险调整后的比较。
结果
患者（n = 9510）接受了解剖性肺切除；4935例（51.9%）为胸腔镜切除术，4575例（48.1%）为开放性切除术。胸腔镜手术患者中，10.9%发生了一种或多种并发症，而开放性切除术患者为19.4%（p < 0.0001）。胸腔镜手术患者中有5.5%发生了相关的计划外再入院，而开放性切除术患者为7.2%（p < 0.001）。胸腔镜手术后24.8%的并发症发生在出院后，而开放性手术后为15.5%（p < 0.0001）。两组计划外再入院的时间相似。胸腔镜与开放性切除术后再入院风险的倾向匹配优势比为1.16（95%置信区间，0.949至1.411，p = 0.15）。
结论
原发性肺癌开放性解剖性肺切除术的并发症发生率几乎是胸腔镜切除术的两倍，但再入院率仅略高。胸腔镜切除术后出院后发生的并发症比开放性切除术更多。胸腔镜和开放性切除术后大多数再入院发生在2周内。风险调整后的比较显示，胸腔镜与开放性切除术后相关计划外再入院风险无统计学显著差异。未来的研究应侧重于确定护理流程，以减少肺癌切除术后的并发症和计划外再入院。
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