Departments of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN 37232.
Department of Radiology, University of Illinois, Chicago, Illinois.
J Vasc Interv Radiol. 2018 Apr;29(4):550-555. doi: 10.1016/j.jvir.2017.11.018. Epub 2018 Mar 1.
To test the hypothesis that same-day discharge of selected transarterial chemoembolization patients would not increase 30-day readmission rate compared with overnight observation.
With institutional review board approval, 193 hepatocellular carcinoma patients who underwent transarterial chemoembolization from July 2013 to June 2016 were reviewed. Treatment was conventional/lipiodol transarterial chemoembolization with 50 mg doxorubicin/10 mg mitomycin-c/particles or drug-eluting embolics transarterial chemoembolization with 50-75 mg doxorubicin/vial. At 3 hours, patients tolerating oral intake and not requiring intravenous analgesics were considered for discharge. The primary outcome measure was 30-day readmission for observation versus discharge using chi-squared (χ) analysis. The secondary aim was to identify baseline or treatment variables independently associated with readmission, including Child-Pugh class, medically managed encephalopathy or ascites, patient age (<65 vs ≥65), tumor number (1 or >1), and level of embolization (segmental vs lobar).
Patients underwent 261 transarterial chemoembolization procedures. The 30-day readmission rate was not significantly different between observed patients (n = 179, 9.0%) and discharged patients (n = 82, 13.8%; P = .33). Readmission was not related to the selected agent (conventional/lipiodol-transarterial chemoembolization, 11.0% vs drug-eluting embolics transarterial chemoembolization, 7.5%; P = .36). Baseline variables associated with readmission were Child-Pugh B/C (χ2 = 7.9, P < .01), history of encephalopathy (χ2 = 15.4, P < 0.01), and ascites (χ2 = 4.4, P < .05). Patient age (<65 vs ≥65), tumor number (1 vs >1), and level of embolization (segmental vs lobar) were not predictive of readmission (all P > .05).
Same-day discharge after transarterial chemoembolization does not increase the risk of 30-day readmission. Child-Pugh B/C patients, as well as those with ascites or encephalopathy, have the highest risk of readmission.
验证以下假设，即选择性经动脉化疗栓塞患者的当日出院不会增加 30 天再入院率，与过夜观察相比。
在机构审查委员会批准下，回顾了 2013 年 7 月至 2016 年 6 月期间接受经动脉化疗栓塞治疗的 193 例肝细胞癌患者。治疗方法为常规/碘油经动脉化疗栓塞，50mg 多柔比星/10mg 丝裂霉素 C/粒或载药栓塞剂经动脉化疗栓塞，50-75mg 多柔比星/瓶。在 3 小时时，如果患者能耐受口服摄入且无需静脉内镇痛剂，则考虑出院。主要观察指标为采用卡方（χ）分析比较观察与出院 30 天再入院的情况。次要目的是确定与再入院独立相关的基线或治疗变量，包括 Child-Pugh 分级、药物治疗性脑病或腹水、患者年龄（<65 岁与≥65 岁）、肿瘤数量（1 个或>1 个）和栓塞水平（节段性与叶性）。
患者接受了 261 次经动脉化疗栓塞术。观察组（n=179，9.0%）和出院组（n=82，13.8%；P=0.33）的 30 天再入院率无显著差异。再入院与所选药物无关（常规/碘油经动脉化疗栓塞 11.0%与载药栓塞剂经动脉化疗栓塞 7.5%；P=0.36）。与再入院相关的基线变量包括 Child-Pugh B/C（χ2=7.9，P<.01）、脑病史（χ2=15.4，P<.01）和腹水（χ2=4.4，P<.05）。患者年龄（<65 岁与≥65 岁）、肿瘤数量（1 个与>1 个）和栓塞水平（节段性与叶性）与再入院无关（均 P>.05）。
经动脉化疗栓塞后当日出院不会增加 30 天再入院的风险。Child-Pugh B/C 患者以及伴有腹水或脑病的患者再入院风险最高。
