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