Gao Xian Hua, Chouhan Hanumant, Gorgun Emre, Stocchi Luca, Ozuner Gokhan
Department of Colorectal Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China.
Department of Colorectal Surgery, Digestive Disease and Surgery Institute-A3, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Int J Colorectal Dis. 2018 Nov;33(11):1617-1625. doi: 10.1007/s00384-018-3052-4. Epub 2018 Apr 20.
Intestinal obstruction is a leading cause of patient mortality and the most common reason for emergent operation in colorectal surgery. The influence of inter-hospital transfer on patients' outcomes varies greatly in different diseases. We aimed to compare the surgical outcomes and medical costs between transferred and directly admitted patients diagnosed with intestinal obstruction in an American tertiary referral center.
All intestinal obstruction patients operated in Cleveland Clinic from Jan 2012 to Dec 2016 were collected from a prospectively maintained database. Preoperative characteristics; surgical outcomes, including intraoperative complication, postoperative complication, readmission, reoperation, and postoperative 30-day mortality; and medical cost were collected. All parameters were compared between two groups before and after propensity score match. Multivariate logistic analysis was used to explore risk factors of surgical outcomes.
A total of 576 patients were included, with 75 in the transferred group and 501 in the directly admitted group. Before match, the transferred patients had longer waiting interval from admission to surgery (p < 0.001), more contaminated or infected wounds (p = 0.02), different surgical procedures (p = 0.02), and similar surgical outcomes and total medical cost (all p > 0.05), compared with the directly admitted group. Multivariate analysis showed that inter-hospital transfer was not an independent predictor of any surgical outcome. After matching to balance the preoperative characteristics between two groups, no significant differences were identified in all surgical outcomes and total medical cost between two groups (all p > 0.05).
Compared with directly admitted patients, transferred intestinal obstruction patients are associated with similar surgical outcomes and similar medical costs.
肠梗阻是导致患者死亡的主要原因，也是结直肠手术中急诊手术最常见的原因。不同疾病中，院间转运对患者预后的影响差异很大。我们旨在比较在美国一家三级转诊中心，被诊断为肠梗阻的转运患者和直接入院患者的手术结局及医疗费用。
收集2012年1月至2016年12月在克利夫兰诊所接受手术的所有肠梗阻患者，数据来自前瞻性维护的数据库。收集术前特征、手术结局，包括术中并发症、术后并发症、再入院、再次手术以及术后30天死亡率，还有医疗费用。在倾向得分匹配前后，对两组的所有参数进行比较。采用多因素逻辑分析来探究手术结局的危险因素。
共纳入576例患者，其中转运组75例，直接入院组501例。匹配前，与直接入院组相比，转运患者从入院到手术的等待时间更长（p<0.001），伤口污染或感染更多（p=0.02），手术方式不同（p=0.02），但手术结局和总医疗费用相似（所有p>0.05）。多因素分析表明，院间转运不是任何手术结局的独立预测因素。在匹配以平衡两组术前特征后，两组在所有手术结局和总医疗费用方面均未发现显著差异（所有p>0.05）。
与直接入院患者相比，转运的肠梗阻患者手术结局相似，医疗费用也相似。
