Kelley Katherine A, Young J Isaac, Bassale Solange, Herzig Daniel O, Martindale Robert G, Sheppard Brett C, Lu Kim C, Tsikitis V Liana
Department of General Surgery, Oregon Health and Sciences University, Portland, Oregon.
Oregon Health and Science University, Biostatistics Shared Resource- Knight Cancer Institute, Portland, Oregon.
J Surg Res. 2018 Jul;227:220-227. doi: 10.1016/j.jss.2018.02.022. Epub 2018 Mar 20.
Many colorectal cancer patients receive complex surgical care remotely. We hypothesized that their readmission rates would be adversely affected after accounting for differences in travel distance from primary/index hospital and correlate with mortality.
We identified 48,481 colorectal cancer patients in the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Travel distance was calculated, using Google Maps, and SAS. Multivariate negative binomial regression was used to identify factors associated with readmission rates. Overall survival was analyzed, using Kaplan-Meier and Cox proportional hazard.
Thirty-day readmissions occurred in 14.9% of the cohort, 27.5% of which were to a nonindex hospital. In the colon and rectal cancer cohorts, readmissions were 14.5% and 16.5%, respectively. Rectal cancer patients had an increase in readmission by 13% (incidence rate ratios [IRR] 1.13; 95% confidence interval [CI] 1.05-1.21). Factors associated with readmission were male gender, advanced disease, length of stay (LOS), discharge disposition, hospital volume, Charlson score, and poverty level (P < 0.05). Greater distance traveled increased the likelihood of readmission but did not affect mortality. Travel distance influences readmission rates but not mortality. Discharge readiness to decrease readmissions is essential for colorectal cancer patients discharged from index hospitals.
许多结直肠癌患者在远程接受复杂的手术治疗。我们假设，在考虑了与初级/索引医院的旅行距离差异后，他们的再入院率会受到不利影响，并且与死亡率相关。
我们在监测、流行病学和最终结果（SEER）-医疗保险数据库中识别出48481例结直肠癌患者。使用谷歌地图和SAS计算旅行距离。采用多变量负二项回归来确定与再入院率相关的因素。使用Kaplan-Meier法和Cox比例风险模型分析总生存率。
该队列中14.9%的患者在30天内再次入院，其中27.5%的患者入住非索引医院。在结肠癌和直肠癌队列中，再入院率分别为14.5%和16.5%。直肠癌患者的再入院率增加了13%（发病率比[IRR]1.13；95%置信区间[CI]1.05-1.21）。与再入院相关的因素包括男性、疾病晚期、住院时间（LOS）、出院处置、医院规模、Charlson评分和贫困水平（P<0.05）。旅行距离越远，再入院的可能性越大，但不影响死亡率。旅行距离影响再入院率，但不影响死亡率。做好出院准备以降低再入院率对于从索引医院出院的结直肠癌患者至关重要。
