Goel Alexander N, Badran Karam W, Mendelsohn Abie H, Chhetri Dinesh K, Sercarz Joel A, Blackwell Keith E, John Maie A St, Long Jennifer L
Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.
Laryngoscope. 2019 Apr;129(4):910-918. doi: 10.1002/lary.27461. Epub 2018 Sep 19.
OBJECTIVES/HYPOTHESIS: Determine the rate, diagnoses, and risk factors associated with 30-day nonelective readmissions for patients undergoing surgery for oropharyngeal cancer.
Retrospective cohort study.
We analyzed the Nationwide Readmissions Database for patients who underwent oropharyngeal cancer surgery between 2010 and 2014. Rates and causes of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission.
Among 16,902 identified cases, the 30-day, nonelective readmission rate was 10.2%, with an average cost per readmission of $14,170. The most common readmission diagnoses were postoperative bleeding (14.1%) and wound complications (12.6%) (surgical site infection [8.6%], dehiscence [2.3%], and fistula [1.7%]). On multivariate regression, significant risk factors for readmission were major ablative surgery (which included total glossectomy, pharyngectomy, and mandibulectomy) (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.06-1.60), advanced Charlson/Deyo comorbidity (OR: 2.00, 95% CI: 1.43-2.79), history of radiation (OR: 1.58, 95% CI: 1.15-2.17), Medicare (OR: 1.34, 95% CI: 1.06-1.69) or Medicaid (OR: 1.82, 95% CI: 1.32-2.50) payer status, index admission from the emergency department (OR: 1.19, 95% CI: 1.02-1.40), and length of stay ≥6 days (OR: 1.57, 95% CI: 1.19-2.08).
In this large database analysis, we found that approximately one in 10 patients undergoing surgery for oropharyngeal cancer is readmitted within 30 days. Procedural complexity, insurance status, and advanced comorbidity are independent risk factors, whereas postoperative bleeding and wound complications are the most common reasons for readmission.
目的/假设：确定接受口咽癌手术患者30天内非选择性再入院率、诊断及相关危险因素。
回顾性队列研究。
我们分析了2010年至2014年间接受口咽癌手术患者的全国再入院数据库。确定30天再入院率及原因。采用多因素逻辑回归识别再入院危险因素。
在16902例确诊病例中，30天非选择性再入院率为10.2%，每次再入院平均费用为14170美元。最常见的再入院诊断为术后出血（14.1%）和伤口并发症（12.6%）（手术部位感染[8.6%]、裂开[2.3%]和瘘管[1.7%]）。多因素回归分析显示，再入院的显著危险因素包括大的根治性手术（包括全舌切除术、咽切除术和下颌骨切除术）（比值比[OR]：1.29，95%置信区间[CI]：1.06 - 1.60）、Charlson/Deyo合并症晚期（OR：2.00，95% CI：1.43 - 2.79）、放疗史（OR：1.58，95% CI：1.15 - 2.17）、医疗保险（OR：...
（原文中Medicare的95% CI区间数据不完整，补充完整后继续翻译）医疗保险（OR：1.34，95% CI：1.06 - 1.69）或医疗补助（OR：1.82，95% CI：1.32 - 2.50）支付状态、急诊室首次入院（OR：1.19，95% CI：1.02 - 1.40）以及住院时间≥6天（OR：1.57，95% CI：1.19 - 2.08）。
在这项大型数据库分析中，我们发现约十分之一接受口咽癌手术的患者在30天内再次入院。手术复杂性、保险状况和晚期合并症是独立危险因素，而术后出血和伤口并发症是再入院最常见的原因。
4。《喉镜》，129：910 - 918，2019年。
