Department of Surgery, Yale School of Medicine, P.O. Box 208062, New Haven, CT, 06520-8062, USA.
National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, P.O. Box 208088, New Haven, CT, 06520-8088, USA.
J Gastrointest Surg. 2019 Jan;23(1):153-162. doi: 10.1007/s11605-018-3929-0. Epub 2018 Sep 4.
The benefits of palliative care (PC) in critical illness are validated across a range of diseases, yet it remains underutilized in surgical patients. This study analyzed patient and hospital factors predictive of PC utilization for elderly patients with colorectal cancer (CRC) requiring emergent surgery.
The National Inpatient Sample was queried for patients aged ≥ 65 years admitted emergently with CRC from 2009 to 2014. Patients undergoing colectomy, enterectomy, or ostomy formation were included and stratified according to documentation of PC consultation during admission. Chi-squared testing identified unadjusted group differences, and multivariable logistic regression identified predictors of PC.
Of 86,573 discharges meeting inclusion criteria, only 3598 (4.2%) had PC consultation. Colectomy (86.6%) and ostomy formation (30.4%) accounted for the operative majority. PC frequency increased over time (2.9% in 2009 to 6.2% in 2014, P < 0.001) and was nearly twice as likely to occur in the West compared with the Northeast (5.7 vs. 3.3%, P < 0.001) and in not-for-profit compared with proprietary hospitals (4.5 vs. 2.3%, P < 0.001). PC patients were more likely to have metastases (60.1 vs. 39.9%, P < 0.001) and die during admission (41.5 vs. 6.4%, P < 0.001). On multivariable logistic regression, PC predictors (P < 0.05) included region outside the Northeast, increasing age, more recent year, and metastatic disease.
In the USA, PC consultation for geriatric patients with surgically managed complicated CRC is low. Regional variation appears to play an important role. With mounting evidence that PC improves quality of life and outcomes, understanding the barriers associated with its provision to surgical patients is paramount.
姑息治疗（PC）在各种疾病中的益处已得到验证，但在外科患者中仍未得到充分利用。本研究分析了预测老年结直肠癌（CRC）患者在需要紧急手术时接受 PC 治疗的患者和医院因素。
从 2009 年至 2014 年，国家住院患者样本中检索了年龄≥65 岁的因 CRC 紧急入院的患者。纳入并分层分析了接受结肠切除术、肠切除术或造口术形成的患者，并根据入院期间是否有 PC 咨询进行记录。卡方检验确定了未调整的组间差异，多变量逻辑回归确定了 PC 的预测因素。
在符合纳入标准的 86573 例出院患者中，只有 3598 例（4.2%）接受了 PC 咨询。结肠切除术（86.6%）和造口术形成（30.4%）占手术的大部分。PC 频率随时间增加（2009 年为 2.9%，2014 年为 6.2%，P<0.001），与东北地区相比，西部地区更有可能发生（5.7%比 3.3%，P<0.001），非营利性医院比私营医院更有可能发生（4.5%比 2.3%，P<0.001）。PC 患者更有可能发生转移（60.1%比 39.9%，P<0.001）和在住院期间死亡（41.5%比 6.4%，P<0.001）。多变量逻辑回归显示，PC 的预测因素（P<0.05）包括东北部以外的地区、年龄增长、较近的年份和转移性疾病。
在美国，接受姑息治疗的老年接受手术治疗的复杂 CRC 患者比例较低。区域差异似乎起着重要作用。鉴于姑息治疗可提高生活质量和治疗效果的证据越来越多，了解与外科患者姑息治疗相关的障碍至关重要。
