Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada.
Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada.
Eur J Cardiothorac Surg. 2018 Oct 1;54(4):683-688. doi: 10.1093/ejcts/ezy155.
Oesophagectomy is a complex operation with the potential for prolonged recovery. The aim of this study was to evaluate healthcare resource utilization, specifically emergency department (ED) visits within 1 year of oesophagectomy, and to identify risk factors for ED visits and frequent ED use (FEDU).
A retrospective cohort study of consecutive oesophagectomies for cancer in all Ontario hospitals was conducted using linked health data (2000-2012) including the ability to identify ED visits at non-index hospitals. Ontario has a single-payer healthcare system with a population of 13.8-million people. Multivariable regression was used to identify independent factors associated with ED visits and FEDU (≥3 ED visits) within 1 year after oesophagectomy.
There were 3344 oesophagectomies with in-hospital mortality of 5.8% (n = 193). Of those discharged, 16.4% (n = 549), 36.0% (n = 1203) and 55.8% (n = 1866) had ED visits within 30 days, 90 days and 1 year, respectively. Higher comorbidity [adjusted odds ratio (aOR) = 1.08, 95% confidence interval (CI): 1.05-1.11, P < 0.0001], rurality (aOR = 1.40, 95% CI: 1.10-1.78, P = 0.006) and receipt of chemotherapy and/or radiation therapy (aOR = 2.55, 95% CI: 2.12-3.08, P < 0.0001) were independent risk factors for ED visits within 1 year of oesophagectomy. Thoracoscopic-assisted surgery was independently associated with decreased ED visits (aOR = 0.67, 95% CI: 0.45-0.99, P = 0.049). Eight hundred and thirteen (24.3%) patients had FEDU. Higher comorbidity (aOR = 1.11, 95% CI: 1.08-1.14, P < 0.0001), rurality (aOR = 1.66, 95% CI: 1.31-2.10, P < 0.0001) and receipt of chemotherapy and/or radiation therapy (aOR = 2.38, 95% CI: 1.93-2.93, P < 0.0001) were independent risk factors for FEDU. One health region had more ED visits (P = 0.04) and more FEDU (P = 0.001) when compared with the other regions. There were higher ED visits and FEDU in the later years of the study period (both P < 0.0001).
ED visits are common after oesophagectomy with almost 25% of patients having ≥3 visits and >50% having ≥1 visit within 1 year of oesophagectomy. We have identified demographic, surgical and regional risk factors for the potential targeted quality improvement.
食管切除术是一种复杂的手术，恢复期可能较长。本研究旨在评估医疗资源的利用情况，特别是食管切除术后 1 年内的急诊就诊情况，并确定急诊就诊和频繁急诊就诊（FEDU）的风险因素。
本研究采用回顾性队列研究，使用链接健康数据（2000-2012 年）对所有安大略省医院进行了癌症食管切除术，包括在非索引医院识别急诊就诊的能力。安大略省拥有单一支付者医疗体系，人口为 1380 万。采用多变量回归分析确定与食管切除术后 1 年内急诊就诊和 FEDU（≥3 次急诊就诊）相关的独立因素。
共进行了 3344 例食管切除术，院内死亡率为 5.8%（n=193）。出院后，分别有 16.4%（n=549）、36.0%（n=1203）和 55.8%（n=1866）在 30 天、90 天和 1 年内有急诊就诊。更高的合并症（调整后的优势比[aOR] = 1.08，95%置信区间[CI]：1.05-1.11，P<0.0001）、农村地区（aOR = 1.40，95%CI：1.10-1.78，P=0.006）和接受化疗和/或放疗（aOR = 2.55，95%CI：2.12-3.08，P<0.0001）是食管切除术后 1 年内急诊就诊的独立风险因素。胸腔镜辅助手术与急诊就诊减少独立相关（aOR = 0.67，95%CI：0.45-0.99，P=0.049）。813 例（24.3%）患者有 FEDU。更高的合并症（aOR = 1.11，95%CI：1.08-1.14，P<0.0001）、农村地区（aOR = 1.66，95%CI：1.31-2.10，P<0.0001）和接受化疗和/或放疗（aOR = 2.38，95%CI：1.93-2.93，P<0.0001）是 FEDU 的独立风险因素。与其他地区相比，有一个地区的急诊就诊次数（P=0.04）和 FEDU 次数（P=0.001）更多。在研究期间的后期，急诊就诊和 FEDU 次数更高（均 P<0.0001）。
食管切除术后急诊就诊很常见，近 25%的患者有≥3 次就诊，≥50%的患者在食管切除术后 1 年内有≥1 次就诊。我们已经确定了潜在的有针对性的质量改进的人口统计学、手术和地区风险因素。
