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根治性胃癌胃切除术后 30 天再入院的发生率、原因和危险因素:2023 例患者的回顾性研究。

Incidence, causes and risk factors for 30-day readmission after radical gastrectomy for gastric cancer: a retrospective study of 2,023 patients.

机构信息

Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, 410013, Changsha, China.

出版信息

Sci Rep. 2018 Jul 12;8(1):10582. doi: 10.1038/s41598-018-28850-8.

Abstract

The aim of this retrospective study was to investigate the incidence of, causes and risk factors for readmission to hospital ≤30 days after discharge of patients who underwent radical gastrectomy for gastric cancer. A total of 2,023 patients underwent radical gastrectomy operations from November 2010 to July 2017 in our hospital. Of these, 60 patients (3.0%) were readmitted within 30 days after their original discharge. The median time span between the index discharge and readmission was 14 days and the median time for readmission was 8 days. The main reasons for readmission were intestinal obstruction (n = 10, 16.7%), intra-abdominal fluid collection (n = 9, 15.0%), abdominal pain (n = 7, 11.7%), nutritional difficulty (n = 4, 6.7%) and anastomotic leakage (n = 4, 6.7%). Five patients (8.3%) required intensive care and 4 patients (6.7%) died from sudden cardiac arrest, gastrointestinal bleeding, sepsis or multiple organ dysfunctions. Multivariate analysis revealed that post-operative complications (Odds Ratio = 5.116, 95% confidence interval: 2.885-9.073, P < 0.001) was the only independent risk factor for readmission. Thus, appropriate strategies on discharge and close follow-ups for these high-risk patients should be drawn up in order to enhance significantly their quality of care.

摘要

本回顾性研究旨在调查因术后并发症而于出院后 30 天内再次入院的接受胃癌根治性胃切除术患者的入院率、病因和危险因素。2010 年 11 月至 2017 年 7 月,我院共对 2023 例患者进行了根治性胃切除术。其中,60 例(3.0%)患者在首次出院后 30 天内再次入院。指数出院和再次入院之间的中位时间间隔为 14 天,再次入院的中位时间为 8 天。再次入院的主要原因是肠梗阻(n=10,16.7%)、腹腔积液(n=9,15.0%)、腹痛(n=7,11.7%)、营养困难(n=4,6.7%)和吻合口漏(n=4,6.7%)。5 例(8.3%)患者需要重症监护,4 例(6.7%)患者因心搏骤停、胃肠道出血、脓毒症或多器官功能障碍而死亡。多变量分析显示,术后并发症(比值比=5.116,95%置信区间:2.885-9.073,P<0.001)是再次入院的唯一独立危险因素。因此,应制定适当的出院策略和对这些高危患者进行密切随访,以显著提高其护理质量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a5b7/6043555/8ac554b4ea15/41598_2018_28850_Fig1_HTML.jpg

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