Mazmudar Aditya, Castle Joshua, Yang Anthony D, Bentrem David J
Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Surg Oncol. 2018 Jul;118(1):7-14. doi: 10.1002/jso.25093. Epub 2018 Jun 27.
The aim of this study was to identify if prolonged length of hospital stay was protective for certain post-discharge complications requiring readmission after pancreatectomy.
Patients undergoing elective pancreatectomy from 2012 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Multivariate regression analyses were conducted to elucidate the association of length of hospital stay (LOS), in-hospital complications, and post-discharge complications with 30-day hospital readmission.
Mean LOS for the readmitted versus not readmitted cohort was 9.01 and 10.36, respectively (P < 0.001). Approximately half of hospital readmissions occur within 7 days of discharge from the hospital. The readmission rate (after hospital discharge) for patients with any in-hospital complication was 13.2%. On the other hand, the readmission rate for patients with any post-discharge complication was 70.8%. Readmission rates were above 85% for patients with the following post-discharge complications: organ/space surgical site infection (SSI), pneumonia, ventilator dependence greater than 48 h, progressive renal insufficiency, sepsis, and septic shock. In a multivariate logistic regression model, prolonged LOS reduced the odds of any post-discharge complication requiring readmission (OR = 0.68, P = 0.01). Specifically, prolonged LOS reduced the odds of a post-discharge organ/space SSI requiring readmission (OR = 0.72, P = 0.02).
Readmission after pancreatectomy primarily occurs due to a new post-discharge event. Furthermore, increased LOS is protective for readmission for post-pancreatectomy complications, particularly those due to post-discharge organ space SSIs. Our findings suggest that solely focusing on reducing LOS in pancreatectomy may lead to the unintended consequence of increasing readmission rates.
本研究旨在确定胰腺切除术后住院时间延长是否对某些需要再次入院的出院后并发症具有保护作用。
在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）中识别出2012年至2013年接受择期胰腺切除术的患者。进行多因素回归分析以阐明住院时间（LOS）、院内并发症和出院后并发症与30天内再次入院之间的关联。
再次入院组与未再次入院组的平均住院时间分别为9.01天和10.36天（P < 0.001）。约一半的再次入院发生在出院后7天内。有任何院内并发症的患者的再次入院率（出院后）为13.2%。另一方面，有任何出院后并发症的患者的再次入院率为70.8%。以下出院后并发症患者的再次入院率高于85%：器官/腔隙手术部位感染（SSI）、肺炎、机械通气依赖超过48小时、进行性肾功能不全、脓毒症和感染性休克。在多因素逻辑回归模型中，住院时间延长降低了需要再次入院的任何出院后并发症的发生几率（OR = 0.68，P = 0.01）。具体而言，住院时间延长降低了出院后器官/腔隙SSI需要再次入院的发生几率（OR = 0.72，P = 0.02）。
胰腺切除术后再次入院主要是由于新的出院后事件。此外，住院时间延长对胰腺切除术后并发症的再次入院具有保护作用，尤其是那些由出院后器官腔隙SSI引起的并发症。我们的研究结果表明，仅专注于缩短胰腺切除术的住院时间可能会导致再次入院率增加的意外后果。
