Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA; Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA; Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA; Department of Surgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Gynecol Oncol. 2019 Feb;152(2):293-297. doi: 10.1016/j.ygyno.2018.11.029. Epub 2018 Nov 27.
Returning home after surgery is a desirable patient-centered outcome associated with decreased costs compared to non-home discharge. Our objective was to develop a preoperative risk-scoring model predicting non-home discharge after surgery for gynecologic malignancy.
Women who underwent surgery involving hysterectomy for gynecologic malignancy from 2013 to 2015 were identified from the Michigan Surgical Quality Collaborative database. Patients were divided by discharge destination, and a multivariable logistic regression model was developed to create a nomogram to assign case-specific risk scores. The model was validated using the National Surgical Quality Improvement Program (NSQIP) database.
Non-home discharge occurred in 3.1% of 2134 women. The proportion of non-home discharges did not differ by cancer diagnosis (uterine 3.5%, ovarian 2.5%, and cervical 1.6%, p = 0.2). Skilled nursing facilities were the most common non-home destination (68.2%). Among patients with comorbidities (hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease /dyspnea, arrhythmia, and history of deep vein thrombosis/pulmonary embolism), non-home discharge was more common in women with 1 (adjusted OR [aOR] 3.4; p = 0.03) or ≥2 of these comorbidities (aOR 5.1; p = 0.003) compared to none. Non-home discharge was more common after laparotomy (aOR 6.7; p < 0.0001) than laparoscopy, and in those aged ≥70 years (aOR 3.4; p < 0.0001) with American Society of Anesthesiologists class ≥ 3 (aOR 4.5; p = 0.0004) and dependent functional status (aOR 8.7; p < 0.0001). The model C-statistic was 0.89. When the model was applied to 4248 eligible patients from the NSQIP dataset, the C-statistic was 0.84 (95% CI: 0.79-0.89).
Non-home discharge after surgery for gynecologic malignancy was predicted with high accuracy in this retrospective analysis.
与非出院相比，手术后回家是一种理想的以患者为中心的结果，可降低成本。我们的目标是建立一个预测妇科恶性肿瘤手术后非出院的术前风险评分模型。
从密歇根州手术质量协作数据库中确定了 2013 年至 2015 年期间因妇科恶性肿瘤接受子宫切除术的女性患者。根据出院地点将患者分组，并建立多变量逻辑回归模型以创建分配特定病例风险评分的列线图。使用国家手术质量改进计划 (NSQIP) 数据库验证该模型。
2134 名女性中有 3.1%的患者非出院。癌症诊断对非出院的比例没有影响（子宫癌 3.5%，卵巢癌 2.5%，宫颈癌 1.6%，p=0.2）。熟练护理设施是最常见的非出院目的地（68.2%）。在合并症患者（高血压、糖尿病、冠心病、慢性阻塞性肺疾病/呼吸困难、心律失常和深静脉血栓形成/肺栓塞史）中，与无这些合并症的女性相比，有 1 种（调整后的优势比[aOR]3.4；p=0.03）或≥2 种合并症的女性非出院更为常见（aOR 5.1；p=0.003）。与腹腔镜手术相比，剖腹手术后非出院更为常见（aOR 6.7；p<0.0001），年龄≥70 岁（aOR 3.4；p<0.0001）的患者，美国麻醉医师协会（ASA）分级≥3（aOR 4.5；p=0.0004）和依赖功能状态（aOR 8.7；p<0.0001）的患者也是如此。该模型的 C 统计量为 0.89。当该模型应用于来自 NSQIP 数据集的 4248 名合格患者时，C 统计量为 0.84（95%CI：0.79-0.89）。
在这项回顾性分析中，妇科恶性肿瘤手术后非出院的预测具有很高的准确性。
